Official Date Stamps

(ii)

(iii)

Official Application No.

Applicant's or Agent's Reference

21

01

International Application No.

International Filing Date

Priority Date

PCT /                         /

(iv)

71

Full Name(s) of Applicant(s)

(v)

Address(es) of Applicant(s)

54

Title of invention

The applicant has claimed priority (if any) as set out in the abovementioned international application

(vi)

This application is for a patent of addition to patent application No.

21

01

(vii)

The abovementioned international application was filed in English or has been published under the Patent Cooperation Treaty in English

(viii)

This application is accompanied by:

1.

Translation of the international application

2.

Certified priority document(s) (sate number) (ix)

3.

Translation(s) of the priority document(s)

4.

A copy of the Form P2 (particulars for the register)

5.

A declaration and power of attorney on form P3

6.

21

01

74

Address of Service:

............................................................................

Signature of Applicant(s) or Agent

RECEIVED

Official date stamp

The duplicate will be returned to the applicant's address for service as proof of lodging but is not valid unless endorsed with official stamp.

...................................................

Registrar of Patent