PATENT COOPERATION TREATY PCT REQUEST FOR OMISSION OF INFORMATION FROM INTERNATIONAL PUBLICATION AND/OR PUBLIC FILE ACCESS (PCT Rules 48.2(l) and 94.1(e)) Applicant's or agent's file reference To: The International Bureau of WIPO 34, chemin des Colombettes 1211 Geneva 20 Switzerland Facsimile No: +41 22 338 82 70 International filing date (day/month/year) Priority date (day/month/year) International application No. Applicant 1. (a) In respect of the international application and any document to be published together with the international application under Rule 48.2, the applicant hereby requests the International Bureau to omit from international publication* the following information (specify): _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ (b) In respect of any other document contained in the file of the International Bureau, the applicant hereby requests the International Bureau to omit from public file access** the following information (specify): _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 2. State the reasons why (1) the information does not obviously serve the purpose of informing the public about the international application, (2) publication of and/or public access to this information would clearly prejudice the personal or economic interests of a person; and (3) there is no prevailing public interest to have access to that information: 3. Except where the omission of above mentioned information results in the omission of an entire sheet, the applicant must submit (a) replacement sheet(s) from which the relevant information has been omitted, and an accompanying letter drawing attention to the differences between the replaced sheet(s) and the replacement sheet(s) (see Rule 26.4). 4. Signature of applicant(s), agent or common representative: Next to each signature, indicate the name of the person signing and the capacity in which the person signs (if such capacity is not obvious from reading this request). ATTENTION * The request to omit information from international publication must be received by the International Bureau prior to the completion of technical preparations for international publication (Rule 48.2(l)). ** The request to omit information from public file access may be submitted at any time (Rule 94.1). Form PCT/IB/384 (July 2016) American LegalNet, Inc. www.FormsWorkFlow.com