Box No. III AGENT OR COMMON REPRESENTATIVE; OR ADDRESS FOR CORRESPONDENCE
Form PCT/IPEA/401 (second sheet) (July 2019)
See Notes to the demand form
Sheet No. . . .
The following person is agent common representative
and has been appointed earlier and represents the applicant(s) also for international preliminary examination.
is hereby appointed and any earlier appointment of (an) agent(s)/common representative is hereby revoked.
is hereby appointed, specifi cally for the procedure before the International Preliminary Examining Authority, in addition to
the agent(s)/common representative appointed earlier.
Name and address:
(Family name followed by given name; for a legal entity, full offi cial designation.
The address must include postal code and name of country.)
Box No. IV BASIS FOR INTERNATIONAL PRELIMINARY EXAMINATION
Statement concerning amendments:*
1. The applicant wishes the international preliminary examination to start on the basis of:
the description as originally fi led, or
as amended under Article 34
the sequence listing as originally fi led, or
as amended under Article 34:
in the form of an Annex C/ST.25 text fi le
on paper or in the form of an image fi le
the claims as originally fi led, or
as amended under Article 19, and/or
as amended under Article 34
the drawings as originally fi led, or
as amended under Article 34
2. The applicant wishes any amendment to the claims under Article 19 to be considered as reversed.
3. Where the IPEA wishes to start the international preliminary examination at the same time as the international search in
accordance with Rule 69.1(b), the applicant requests the IPEA to postpone the start of the international preliminary examination
until the expiration of the applicable time limit under Rule 69.1(d).
4. The applicant expressly requests to postpone the start of the international preliminary examination until the expiration of the
applicable time limit under Rule 54bis.1(a).
* Where no check-box is marked, international preliminary examination will start on the basis of the international application as originally
fi led or, where a copy of amendments to the claims under Article 19 and/or amendments of the international application under
Article 34 are received by the International Preliminary Examining Authority before it has begun to draw up a written opinion or the
international preliminary examination report, as so amended.
Box No. V ELECTION OF STATES
The fi ling of this demand constitutes the election of all Contracting States which are designated and are bound by Chapter II of the PCT.
Address for correspondence:
Mark this check-box where no agent or common representative is/has been appointed and the
space above is used instead to indicate a special address to which correspondence should be sent.
Telephone No.
Agent’s registration No. with the Offi ce
Facsimile No.
International application No.
Language for the purposes of international preliminary examination: ________________________________________________
which is the language in which the international application was fi led.
which is the language of a translation furnished for the purposes of international search.
which is the language of publication of the international application.
which is the language of the translation (to be) furnished for the purposes of international preliminary examination.
E-mail authorization: Marking one of the check-boxes below authorizes the International Bureau and the International Preliminary
Examining Authority to use the e-mail address indicated in this Box to send notifi cations issued in respect of this international application
if those offi ces are willing to do so.
E-mail address: ___________________________________________________________________________
as advance copies followed by paper notifi cations; or
exclusively in electronic form (no paper notifi cations will be sent).
(if any)
(if any)
DAVIS, Catherine
2500 Virginia Avenue, N.W.
Washington, D.C. 20037-1902
United States of America