PATENT COOPERATION TREATY From the INTERNATIONAL BUREAU PCT To: NOTIFICATION OF REFUND OF FEES CONCERNING SUPPLEMENTARY INTERNATIONAL SEARCH (PCT Rules 45bis.2(d) and 45bis.3(d)) Date of mailing (day/month/year) Applicant’s or agent’s file reference INFORMATION ONLY International filing date (day/month/year) International application No. Applicant 1. The applicant is hereby notified that the amount(s) indicated below which has (have) been paid in respect of the request for supplementary international search by the Authority specified for supplementary search (SISA/ _________________ ) will be refunded for the following reason: a. the international application has been withdrawn, or considered withdrawn, before the transmittal of the documents referred to in Rule 45bis.4(e)(i) to (iv) to the Authority specified for supplementary search b. the supplementary search request has been withdrawn, or considered not to have been submitted before the transmittal of the documents referred to in Rule 45bis.4(e)(i) to (iv) to the Authority specified for supplementary search 2. Amount(s) to be refunded: Supplementary Search Handling Fee : ______________________________________ Supplementary Search Fee : ______________________________________ Total : ______________________________________ 3. The above amount(s) will be refunded separately. The International Bureau of WIPO 34, chemin des Colombettes 1211 Geneva 20, Switzerland Facsimile No. +41 22 338 82 70 Authorized officer Telephone No. +41 22 338 XX XX Form PCT/IB/381 (July 2010) American LegalNet, Inc. www.FormsWorkFlow.com