Form PCT/RO/101 (continuation sheet) () See Notes to the request form State (that is, country) of nationality:State (that is, country) of residence: State (that is, country) of nationality:State (that is, country) of residence:Name and address: State (that is, country) of nationality:State (that is, country) of residence: State (that is, country) of nationality:State (that is, country) of residence:Name and address:Name and address: Sheet No. . . . . . . .Box No. IIIFURTHER APPLICANT(S) AND/OR (FURTHER) INVENTOR(S)If none of the following sub-boxes is used, this sheet should not be included in the request. Further applicants and/or (further) inventors are indicated on another continuation sheet.Name and address:(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.)(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.)(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.)(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.) Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box American LegalNet, Inc. www.FormsWorkFlow.com Form PCT/RO/101 (continuation sheet) () See Notes to the request form State (that is, country) of nationality:State (that is, country) of residence: State (that is, country) of nationality:State (that is, country) of residence:Name and address: State (that is, country) of nationality:State (that is, country) of residence: State (that is, country) of nationality:State (that is, country) of residence:Name and address:Name and address: Sheet No. . . . . . . .Box No. IIIFURTHER APPLICANT(S) AND/OR (FURTHER) INVENTOR(S)If none of the following sub-boxes is used, this sheet should not be included in the request. Further applicants and/or (further) inventors are indicated on another continuation sheet.Name and address:(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.)(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.)(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.)(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country. The country of the address indicated in thisBox is the applicant222s State (that is, country) of residence if no State of residence is indicated below.) Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only Applicant222s registration No. with the Officeinventor only (If this check-boxis marked, do not fill in below.) applicant and inventorThis person is: applicant only This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box American LegalNet, Inc. www.FormsWorkFlow.com