Box No. IIAPPLICANT Box No. ITITLE OF INVENTION PCTThe undersigned requests that the presentinternational application be processedaccording to the Patent Cooperation Treaty.REQUEST Applicant222s or agent222s file reference(if desired) (12 characters maximum) For receiving Office use onlyInternational Application No.International Filing DateName of receiving Office and 223PCT International Application224Name 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.) This person is also inventor This person is applicantfor the purposes of: all designated Statesthe States indicated in the Supplemental Box State (that is, country) of residence:State (that is, country) of nationality: Box No. IIIFURTHER APPLICANT(S) AND/OR (FURTHER) INVENTOR(S) Box No. IVAGENT OR COMMON REPRESENTATIVE; OR ADDRESS FOR CORRESPONDENCEThe person identified below is hereby/has been appointed to act on behalfof the applicant(s) before the competent International Authorities as: Name and address: Further applicants and/or (further) inventors are indicated on a continuation sheet.agentcommonrepresentative(Family name followed by given name; for a legal entity, full official designation.The address must include postal code and name of country.)See Notes to the request form Form PCT/RO/101 (first sheet) (July 2018)Address for correspondence: Mark this check-box where no agent or common representative is/has been appointed and thespace above is used instead to indicate a special address to which correspondence should be sent.Telephone No. Agent222s registration No. with the Office Facsimile No. Telephone No. Applicant222s registration No. with the Office Facsimile No. E-mail authorization: Marking one of the check-boxes below authorizes the receiving Office, the International Searching Authority, theInternational Bureau and the International Preliminary Examining Authority to use the e-mail address indicated in this Box to send,notifications issued in respect of this international application to that e-mail address if those offices are willing to do so.E-mail address: as advance copies followed by paper notifications; or exclusively in electronic form (no paper notifications will be sent).E-mail authorization: Marking one of the check-boxes below authorizes the receiving Office, the International Searching Authority, theInternational Bureau and the International Preliminary Examining Authority to use the e-mail address indicated in this Box to send,notifications issued in respect of this international application to that e-mail address if those offices are willing to do so.E-mail address: as advance copies followed by paper notifications; or exclusively in electronic form (no paper notifications will be sent). American LegalNet, Inc. www.FormsWorkFlow.com Form PCT/RO/101 (continuation sheet) (July 2018)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 Sheet No. . . . . . . . Supplemental Box If the Supplemental Box is not used, this sheet should not be included in the request.See Notes to the request formForm PCT/RO/101 (supplemental sheet) (July 2018)1.If, in any of the Boxes, except Boxes Nos. VIII(i) to (v) for whicha special continuation box is provided, the space is insufficientto furnish all the information: in such case, write 223Continuationof Box No....224 (indicate the number of the Box) and furnish theinformation in the same manner as required according to thecaptions of the Box in which the space was insufficient, inparticular:(i)if more than one person is to be indicated as applicant and/orinventor and no 223continuation sheet224 is available: in suchcase, write 223Continuation of Box No. III224 and indicate for eachadditional person the same type of information as required inBox No. III. The country of the address indicated in this Box isthe applicant222s State (that is, country) of residence if no State ofresidence is indicated below;(ii)if, in Box No. II or in any of the sub-boxes of Box No. III, theindication 223the States indicated in the Supplemental Box224 ischecked: in such case, write 223Continuation of Box No. II224 or223Continuation of Box No. III224 or 223Continuation of Boxes No. IIand No. III224 (as the case may be), indicate the name of theapplicant(s) involved and, next to (each) such name, the State(s)(and/or, where applicable, ARIPO, Eurasian, European orOAPI patent) for the purposes of which the named person isapplicant;(iii)if, in Box No. II or in any of the sub-boxes of Box No. III, theinventor or the inventor/applicant is not inventor for thepurposes of all designated States: in such case, write223Continuation of Box No. II224 or 223Continuation of Box No. III224or 223Continuation of Boxes No. II and No. III224 (as the case maybe), indicate the name of the inventor(s) and, next to (each)such name, the State(s) (and/or, where applicable, ARIPO,Eurasian, European or OAPI patent) for the purposes of whichthe named person is inventor;(iv)if, in addition to the agent(s) indicated in Box No. IV, there