Form PCT/RO/101 Request and Fee Calculation Sheet (Annex and Notes)

For receiving Office use only

PCT

International Application No.

REQUEST
International Filing Date

The undersigned requests that the present
international application be processed
according to the Patent Cooperation Treaty.

Name of receiving Office and “PCT International Application”
Applicant’s or agent’s file reference
(if desired) (12 characters maximum)

Box No. I

TITLE OF INVENTION

Box No. II

APPLICANT

This person is also inventor

Name and address: (Family name followed by given name; for a legal entity, full official designation. Telephone No.
The address must include postal code and name of country. The country of the address indicated in this
Box is the applicant’s State (that is, country) of residence if no State of residence is indicated below.)

Facsimile No.
Applicant’s registration No. with the Office

E-mail authorization: Marking one of the check-boxes below authorizes the receiving Office, the International Searching Authority, the
International 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.
exclusively in electronic form (no paper notifications will be sent).
as advance copies followed by paper notifications; or
E-mail address:
State (that is, country) of nationality:
State (that is, country) of residence:
This person is applicant
for the purposes of:
Box No. III

all designated States

the States indicated in the Supplemental Box

FURTHER APPLICANT(S) AND/OR (FURTHER) INVENTOR(S)

Further applicants and/or (further) inventors are indicated on a continuation sheet.
Box No. IV

AGENT OR COMMON REPRESENTATIVE; OR ADDRESS FOR CORRESPONDENCE

The person identified below is hereby/has been appointed to act on behalf
of the applicant(s) before the competent International Authorities as:

agent

common
representative

Name and address: (Family name followed by given name; for a legal entity, full official designation. Telephone No.
The address must include postal code and name of country.)

Facsimile No.
Agent’s registration No. with the Office

E-mail authorization: Marking one of the check-boxes below authorizes the receiving Office, the International Searching Authority, the
International 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.
exclusively in electronic form (no paper notifications will be sent).
as advance copies followed by paper notifications; or
E-mail address:
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.
Form PCT/RO/101 (first sheet) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. III

FURTHER 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.
Name and address: (Family name followed by given name; for a legal entity, full official designation. This person is:
The address must include postal code and name of country. The country of the address indicated in this
Box is the applicant’s State (that is, country) of residence if no State of residence is indicated below.)

applicant only
applicant and inventor
inventor only (If this check-box
is marked, do not fill in below.)
Applicant’s registration No. with the Office

State (that is, country) of nationality:
This person is applicant
for the purposes of:

all designated States

State (that is, country) of residence:

the States indicated in the Supplemental Box

Name and address: (Family name followed by given name; for a legal entity, full official designation. This person is:
The address must include postal code and name of country. The country of the address indicated in this
Box is the applicant’s State (that is, country) of residence if no State of residence is indicated below.)

applicant only
applicant and inventor
inventor only (If this check-box
is marked, do not fill in below.)
Applicant’s registration No. with the Office

State (that is, country) of nationality:
This person is applicant
for the purposes of:

all designated States

State (that is, country) of residence:

the States indicated in the Supplemental Box

Name and address: (Family name followed by given name; for a legal entity, full official designation. This person is:
The address must include postal code and name of country. The country of the address indicated in this
Box is the applicant’s State (that is, country) of residence if no State of residence is indicated below.)

applicant only
applicant and inventor
inventor only (If this check-box
is marked, do not fill in below.)
Applicant’s registration No. with the Office

State (that is, country) of nationality:
This person is applicant
for the purposes of:

all designated States

State (that is, country) of residence:

the States indicated in the Supplemental Box

Name and address: (Family name followed by given name; for a legal entity, full official designation. This person is:
The address must include postal code and name of country. The country of the address indicated in this
Box is the applicant’s State (that is, country) of residence if no State of residence is indicated below.)

applicant only
applicant and inventor
inventor only (If this check-box
is marked, do not fill in below.)
Applicant’s registration No. with the Office

State (that is, country) of nationality:
This person is applicant
for the purposes of:

all designated States

State (that is, country) of residence:

the States indicated in the Supplemental Box

Further applicants and/or (further) inventors are indicated on another continuation sheet.
Form PCT/RO/101 (continuation sheet) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Supplemental Box

1.

(i)

(ii)

(iii)

(iv)

(v)

If the Supplemental Box is not used, this sheet should not be included in the request.

If, in any of the Boxes, except Boxes Nos. VIII(i) to (v) for which
a special continuation box is provided, the space is insufficient
to furnish all the information: in such case, write “Continuation
of Box No....” (indicate the number of the Box) and furnish the
information in the same manner as required according to the
captions of the Box in which the space was insufficient, in
particular:
if more than one person is to be indicated as applicant and/or
inventor and no “continuation sheet” is available: in such
case, write “Continuation of Box No. III” and indicate for each
additional person the same type of information as required in
Box No. III. The country of the address indicated in this Box is
the applicant’s State (that is, country) of residence if no State of
residence is indicated below;
if, in Box No. II or in any of the sub-boxes of Box No. III, the
indication “the States indicated in the Supplemental Box” is
checked: in such case, write “Continuation of Box No. II” or
“Continuation of Box No. III” or “Continuation of Boxes No. II
and No. III” (as the case may be), indicate the name of the
applicant(s) involved and, next to (each) such name, the State(s)
(and/or, where applicable, ARIPO, Eurasian, European or
OAPI patent) for the purposes of which the named person is
applicant;
if, in Box No. II or in any of the sub-boxes of Box No. III, the
inventor or the inventor/applicant is not inventor for the
purposes of all designated States: in such case, write
“Continuation of Box No. II” or “Continuation of Box No. III”
or “Continuation of Boxes No. II and No. III” (as the case may
be), 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 which
the named person is inventor;
if, in addition to the agent(s) indicated in Box No. IV, there are
further agents: in such case, write “Continuation of
Box No. IV” and indicate for each further agent the same type
of information as required in Box No. IV;
if, in Box No. VI, there are more than three earlier applications
whose priority is claimed: in such case, write “Continuation
of Box No. VI” and indicate for each additional earlier
application the same type of information as required
in Box No. VI.

2.

If the applicant intends to make an indication of the wish that
the international application be treated, in certain designated
States, as an application for a patent of addition, certificate of
addition, inventor’s certificate of addition or utility certificate
of addition: in such case, write the name or two-letter code of
each designated State concerned and the indication “patent of
addition,” “certificate of addition,” “inventor’s certificate of
addition” or “utility certificate of addition,” the number of the
parent application or parent patent or other parent grant and
the date of grant of the parent patent or other parent grant or
the date of filing of the parent application (Rules 4.11(a)(i)
and 49bis.1(a) or (b)).

3.

If the applicant intends to make an indication of the wish that
the international application be treated, in the United States of
America, as a continuation or continuation-in-part of an
earlier application: in such case, write “United States of
America” or “US” and the indication “continuation” or
“continuation-in-part” and the number and the filing date of
the parent application (Rules 4.11(a)(ii) and 49bis.1(d)).

Form PCT/RO/101 (supplemental sheet) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. V

DESIGNATIONS

The filing of this request constitutes under Rule 4.9(a) the designation of all Contracting States bound by the PCT on the international
filing date, for the grant of every kind of protection available and, where applicable, for the grant of both regional and national patents.
However,
DE Germany is not designated for any kind of national protection
JP Japan is not designated for any kind of national protection
KR Republic of Korea is not designated for any kind of national protection
(The check-boxes above may only be used to exclude (irrevocably) the designations concerned if, at the time of filing or subsequently under
Rule 26bis.1, the international application contains in Box No. VI a priority claim to an earlier national application filed in the particular
State concerned, in order to avoid the ceasing of the effect, under the national law, of this earlier national application.)
Box No. VI

PRIORITY CLAIM AND DOCUMENT

The priority of the following earlier application(s) is hereby claimed:
Number
of earlier application

Filing date
of earlier application
(day/month/year)

Where earlier application is:
national application: regional application: international application:
country or Member
regional Office
receiving Office
of WTO

item (1)

item (2)

item (3)

Further priority claims are indicated in the Supplemental Box.
Furnishing the priority document(s):
The receiving Office is requested to prepare and transmit to the International Bureau a certified copy of the earlier application(s)
(only if the earlier application(s) was filed with the receiving Office which, for the purposes of this international application, is
the receiving Office) identified above as:
all items

item (1)

item (2)

item (3)

other, see Supplemental Box

The International Bureau is requested to obtain from a digital library a certified copy of the earlier application(s) identified above,
using, where applicable, the access code(s) indicated below (if the earlier application(s) is available to it from a digital library):
item (1)
access code ______________

item (2)
access code ______________

item (3)
access code _______________

other, see
Supplemental Box

Restore the right of priority: the receiving Office is requested to restore the right of priority for the earlier application(s) identified
above or in the Supplemental Box as item(s) (_________________________________). (See also the Notes to Box No. VI; further
information must be provided to support a request to restore the right of priority.)
Incorporation by reference: where an element of the international application referred to in Article 11(1)(iii)(d) or (e) or a part of
the description, claims or drawings referred to in Rule 20.5(a) is not otherwise contained in this international application but is
completely contained in an earlier application whose priority is claimed on the date on which one or more elements referred to in
Article 11(1)(iii) were first received by the receiving Office, that element or part is, subject to confirmation under Rule 20.6,
incorporated by reference in this international application for the purposes of Rule 20.6.
Box No. VII

INTERNATIONAL SEARCHING AUTHORITY

Choice of International Searching Authority (ISA) (if more than one International Searching Authority is competent to carry out the
international search, indicate the Authority chosen; the two-letter code may be used):
ISA/ _____________________________________________________________________________________________________
Form PCT/RO/101 (second sheet) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Continuation of Box No. VII

USE OF RESULTS OF EARLIER SEARCH, REFERENCE TO THAT SEARCH

The ISA indicated in Box No. VII is requested to take into account the results of the earlier search(es) indicated below (see also
Notes to Box VII; use of results of more than one earlier search).
Filing date (day/month/year)

Application Number

Country (or regional Office)

Statement (Rule 4.12(ii)): this international application is the same, or substantially the same, as the application in respect of
which the earlier search was carried out except, where applicable, that it is filed in a different language.
Availability of documents: the following documents are available to the ISA in a form and manner acceptable to it and therefore
do not need to be submitted by the applicant to the ISA (Rule 12bis.1(f)):
a copy of the results of the earlier search,*
a copy of the earlier application,
a translation of the earlier application into a language which is accepted by the ISA,
a translation of the results of the earlier search into a language which is accepted by the ISA,
a copy of any document cited in the results of the earlier search. (If known, please indicate below the document(s) available
to the ISA):
Transmit copy of results of earlier search and other documents (where the earlier search was not carried out by the ISA
indicated above but by the same Office as that which is acting as the receiving Office): the receiving Office is requested to
prepare and transmit to the ISA (Rule 12bis.1(c)):
a copy of the results of the earlier search,*
a copy of the earlier application,
a copy of any document cited in the results of the earlier search.
* Where the results of the earlier search are neither available from a digital library nor transmitted by the receiving Office, the applicant
is required to submit them to the receiving Office (Rule 12bis.1(a)) (See item 11. in the check-list and also Notes to Box No. VII).
Filing date (day/month/year)

Application Number

Country (or regional Office)

Statement (Rule 4.12(ii)): this international application is the same, or substantially the same, as the application in respect of
which the earlier search was carried out except, where applicable, that it is filed in a different language.
Availability of documents: the following documents are available to the ISA in a form and manner acceptable to it and therefore
do not need to be submitted by the applicant to the ISA (Rule 12bis.1(f)):
a copy of the results of the earlier search,*
a copy of the earlier application,
a translation of the earlier application into a language which is accepted by the ISA,
a translation of the results of the earlier search into a language which is accepted by the ISA,
a copy of any document cited in the results of the earlier search. (If known, please indicate below the document(s) available
to the ISA):
Transmit copy of results of earlier search and other documents (where the earlier search was not carried out by the ISA
indicated above but by the same Office as that which is acting as the receiving Office): the receiving Office is requested to
prepare and transmit to the ISA (Rule 12bis.1(c)):
a copy of the results of the earlier search,*
a copy of the earlier application,
a copy of any document cited in the results of the earlier search.
* Where the results of the earlier search are neither available from a digital library nor transmitted by the receiving Office, the applicant
is required to submit them to the receiving Office (Rule 12bis.1(a)) (See item 11. in the check-list and also Notes to Box No. VII).
Further earlier searches are indicated on a continuation sheet.
Box No. VIII DECLARATIONS
The following declarations are contained in Boxes Nos. VIII (i) to (v) (mark the applicable
check-boxes below and indicate in the right column the number of each type of declaration):

Number of
declarations

Box No. VIII (i)

Declaration as to the identity of the inventor

:

Box No. VIII (ii)

Declaration as to the applicant’s entitlement, as at the international filing
date, to apply for and be granted a patent

:

Box No. VIII (iii)

Declaration as to the applicant’s entitlement, as at the international filing
date, to claim the priority of the earlier application

:

Declaration of inventorship (only for the purposes of the designation of the
United States of America)

:

Declaration as to non-prejudicial disclosures or exceptions to lack of novelty

:

Box No. VIII (iv)
Box No. VIII (v)

Form PCT/RO/101 (third sheet) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. VIII (i)

DECLARATION: IDENTITY OF THE INVENTOR

The declaration must conform to the standardized wording provided for in Section 211; see Notes to Boxes Nos. VIII, VIII (i) to (v) (in general)
and the specific Notes to Box No.VIII (i). If this Box is not used, this sheet should not be included in the request.
Declaration as to the identity of the inventor (Rules 4.17(i) and 51bis.1(a)(i)):

This declaration is continued on the following sheet, “Continuation of Box No. VIII (i)”.
Form PCT/RO/101 (declaration sheet (i)) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. VIII (ii) DECLARATION: ENTITLEMENT TO APPLY FOR AND BE GRANTED A PATENT
The declaration must conform to the standardized wording provided for in Section 212; see Notes to Boxes Nos. VIII, VIII (i) to (v) (in general)
and the specific Notes to Box No.VIII (ii). If this Box is not used, this sheet should not be included in the request.
Declaration as to the applicant’s entitlement, as at the international filing date, to apply for and be granted a patent (Rules 4.17(ii)
and 51bis.1(a)(ii)), in a case where the declaration under Rule 4.17(iv) is not appropriate:

This declaration is continued on the following sheet, “Continuation of Box No. VIII (ii)”.
Form PCT/RO/101 (declaration sheet (ii)) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. VIII (iii)

DECLARATION: ENTITLEMENT TO CLAIM PRIORITY

The declaration must conform to the standardized wording provided for in Section 213; see Notes to Boxes Nos. VIII, VIII (i) to (v) (in general)
and the specific Notes to Box No.VIII (iii). If this Box is not used, this sheet should not be included in the request.
Declaration as to the applicant’s entitlement, as at the international filing date, to claim the priority of the earlier application specified
below, where the applicant is not the applicant who filed the earlier application or where the applicant’s name has changed since the
filing of the earlier application (Rules 4.17(iii) and 51bis.1(a)(iii)):

This declaration is continued on the following sheet, “Continuation of Box No. VIII (iii)”.
Form PCT/RO/101 (declaration sheet (iii)) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. VIII (iv) DECLARATION: INVENTORSHIP (only for the purposes of the designation of the United States of America)
The declaration must conform to the following standardized wording provided for in Section 214; see Notes to Boxes Nos. VIII, VIII (i) to (v)
(in general) and the specific Notes to Box No.VIII (iv). If this Box is not used, this sheet should not be included in the request.
Declaration of inventorship (Rules 4.17(iv) and 51bis.1(a)(iv))
for the purposes of the designation of the United States of America:
I hereby declare that I believe I am the original inventor or an original joint inventor of a claimed invention in the application.
This declaration is directed to the international application of which it forms a part (if filing declaration with application).
This declaration is directed to international application No. PCT/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (if furnishing declaration pursuant
to Rule 26ter).
I hereby declare that the above-identified international application was made or authorized to be made by me.
I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001 by fine or
imprisonment of not more than five (5) years, or both.
Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Residence: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(city and either US state, if applicable, or country)
Mailing Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................................................................
.................................................................................
Inventor’s Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(The signature must be that of the inventor, not that of the agent)

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Residence: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(city and either US state, if applicable, or country)
Mailing Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................................................................
.................................................................................
Inventor’s Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(The signature must be that of the inventor, not that of the agent)

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Residence: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(city and either US state, if applicable, or country)
Mailing Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................................................................
.................................................................................
Inventor’s Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(The signature must be that of the inventor, not that of the agent)

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

This declaration is continued on the following sheet, “Continuation of Box No. VIII (iv)”.
Form PCT/RO/101 (declaration sheet (iv)) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. VIII (v) DECLARATION: NON-PREJUDICIAL DISCLOSURES OR EXCEPTIONS TO LACK OF NOVELTY
The declaration must conform to the standardized wording provided for in Section 215; see Notes to Boxes Nos. VIII, VIII (i) to (v) (in general)
and the specific Notes to Box No.VIII (v). If this Box is not used, this sheet should not be included in the request.
Declaration as to non-prejudicial disclosures or exceptions to lack of novelty (Rules 4.17(v) and 51bis.1(a)(v)):

This declaration is continued on the following sheet, “Continuation of Box No. VIII (v)”.
Form PCT/RO/101 (declaration sheet (v)) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Continuation of Box No. VIII (i) to (v) DECLARATION
If the space is insufficient in any of Boxes Nos. VIII (i) to (v) to furnish all the information, including in the case where more than two inventors
are to be named in Box No. VIII (iv), in such case, write “Continuation of Box No. VIII ...” (indicate the item number of the Box) and furnish
the information in the same manner as required for the purposes of the Box in which the space was insufficient. If additional space is needed
in respect of two or more declarations, a separate continuation box must be used for each such declaration. If this Box is not used, this sheet
should not be included in the request.

Form PCT/RO/101 (continuation sheet for declaration) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. IX

CHECK LIST for PAPER filings – this sheet is only to be used when filing an international application on PAPER

This international application
contains the following:

Number
of sheets

This international application is accompanied by the
following item(s) (mark the applicable check-boxes below
and indicate in right column the number of each item):

(a) request form
PCT/RO/101
(including any
declarations and
supplemental
sheets) . . . . . . . . . . . . . . . . . . . . . :
(b) description
(excluding any
sequence listing
part of the
description,
see (f), below) . . . . . . . . . . . . . . . :

1.

fee calculation sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

2.

original separate power of attorney . . . . . . . . . . . . . . . .

:

3.

original general power of attorney . . . . . . . . . . . . . . . . .

:

4.

copy of general power of attorney; reference
number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

priority document(s) identified in Box No. VI
as item(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

Translation of international application into
(language): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

separate indications concerning deposited
microorganism or other biological material . . . . . . . . . .

:

5.
6.
7.

(c) claims . . . . . . . . . . . . . . . . . . . . . :
(d) abstract . . . . . . . . . . . . . . . . . . . . :

8.

copy in electronic form (Annex C/ST.25 text file) on
physical data carrier(s) of the sequence listing, not forming
part of the international application, which is furnished only
for the purposes of international search under Rule 13ter
(type and number of physical data carriers) . . . . . . . . . .
............................................. :

9.

a statement confirming that “the information
recorded in electronic form submitted under
Rule 13ter is identical to the sequence listing
as contained in the international application”
as filed on paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

10.

copy of results of earlier search(es) (Rule 12bis.1(a)) . .

:

11.

other (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

(e) drawings (if any) . . . . . . . . . . . . :
(f) sequence listing
part of the
description (if any) . . . . . . . . . . . :

Total number of sheets

:

0

Language of filing of the
international application:

Figure of the drawings which
should accompany the abstract:
Box No. X

Number
of items

SIGNATURE OF APPLICANT, AGENT OR COMMON REPRESENTATIVE

Next to each signature, indicate the name of the person signing and the capacity in which the person signs (if such capacity is not obvious from reading the request).

For receiving Office use only
1. Date of actual receipt of the purported
international application:

2. Drawings:

3. Corrected date of actual receipt due to later but
timely received papers or drawings completing
the purported international application:

received:

4. Date of timely receipt of the required
corrections under PCT Article 11(2):

not received:

5. International Searching Authority
(if two or more are competent):

6.

ISA /

Transmittal of search copy delayed
until search fee is paid

For International Bureau use only
Date of receipt of the record copy
by the International Bureau:
Form PCT/RO/101 (last sheet – paper) (16 September 2012)

See Notes to the request form

Sheet No. . . . . . . .
Box No. IX

CHECK LIST for EFS-Web filings - this sheet is only to be used when filing an international application with RO/US via EFS-Web
Number This international application is accompanied by the
of sheets following item(s) (mark the applicable check-boxes below
and indicate in right column the number of each item):

This international application
contains the following:
(a) request form PCT/RO/101
(including any declarations
and supplemental sheets) . . . . . . . :
(b) description (excluding any
sequence listing part of the
description, see (f), below) . . . . . :

Number
of items

1.

fee calculation sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

2.

original separate power of attorney . . . . . . . . . . . . . . . .

:

3.

original general power of attorney . . . . . . . . . . . . . . . . .

:

4.

copy of general power of attorney; reference
number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

priority document(s) identified in Box No. VI
as item(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

Translation of international application into
(language): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

separate indications concerning deposited
microorganism or other biological material . . . . . . . . . .

:

(only where item (f) is marked in the left column)
copy of the sequence listing in electronic
form (Annex C/ST.25 text file) not forming
part of the international application but
furnished only for the purposes of
international search under Rule 13ter . . . . . . . . . . . . . .

:

(only where item (f) is marked in the left column)
a statement confirming that “the information
recorded in electronic form submitted under
Rule 13ter is identical to the sequence listing
as contained in the international application”
as filed via EFS-Web: . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

10.

copy of results of earlier search(es) (Rule 12bis.1(a)) . .

:

11.

other (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

(c) claims . . . . . . . . . . . . . . . . . . . . . . :
5.
(d) abstract . . . . . . . . . . . . . . . . . . . . . :
(e) drawings (if any) . . . . . . . . . . . . . :

6.

(f) sequence listing part of the
description in the form of an
image file (e.g. PDF) . . . . . . . . . . :

7.
8.

Total number of sheets (including the
sequence listing part of the description
if filed as an image file) . . . . . . . . . . :

0

(g) sequence listing part of the description

9.

filed in the form of an Annex C/ST.25 text
file
WILL BE filed separately on physical data
carrier(s), on the same day and in the form
of an Annex C/ST.25 text file
Indicate type and number of physical data
carrier(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Language of filing of the
international application:

Figure of the drawings which
should accompany the abstract:
Box No. X

SIGNATURE OF APPLICANT, AGENT OR COMMON REPRESENTATIVE

Next to each signature, indicate the name of the person signing and the capacity in which the person signs (if such capacity is not obvious from reading the request).

For receiving Office use only
1. Date of actual receipt of the purported
international application:

2. Drawings:

3. Corrected date of actual receipt due to later but
timely received papers or drawings completing
the purported international application:

received:

4. Date of timely receipt of the required
corrections under PCT Article 11(2):

not received:

5. International Searching Authority
(if two or more are competent):

6.

ISA /

Transmittal of search copy delayed
until search fee is paid

For International Bureau use only
Date of receipt of the record copy
by the International Bureau:
Form PCT/RO/101 (last sheet – EFS) (16 September 2012)

See Notes to the request form

NOTES TO THE REQUEST FORM (PCT/RO/101)
These Notes are intended to facilitate the filling in of the request form. For more detailed information, see the PCT Applicant’s
Guide, a WIPO publication, which is available, together with other PCT related documents, at WIPO’s website:
www.wipo.int/pct/en/. The Notes are based on the requirements of the Patent Cooperation Treaty (PCT), the Regulations and the
Administrative Instructions under the PCT. In case of any discrepancy between these Notes and those requirements, the latter are
applicable.
In the request form and these Notes, “Article”, “Rule” and “Section” refer to the provisions of the PCT, the PCT Regulations
and the PCT Administrative Instructions, respectively.
The request form should be typed or printed; check-boxes may be marked by hand with black ink (Rule 11.9(a) and (b)).
The request form and these Notes may be downloaded from WIPO’s website at the address given above.
WHERE TO FILE
THE INTERNATIONAL APPLICATION
The international application (request, description, claims,
abstract and drawings, if any) must be filed with a competent
receiving Office (Article 11(1)(i)) – that is, subject to any
applicable prescriptions concerning national security, at the
choice of the applicant, either:
(i) the receiving Office of, or acting for, a PCT Contracting
State of which the applicant or, if there are two or more
applicants, at least one of them, is a resident or national
(Rule 19.1(a)(i) or (ii) or (b)), or
(ii) the International Bureau of WIPO in Geneva,
Switzerland, if the applicant or, if there are two or more
applicants, at least one of the applicants is a resident or national
of any PCT Contracting State (Rule 19.1(a)(iii)).

Check-box “applicant and inventor” (Box No. III): Mark
this check-box if the person named is both applicant and
inventor; do not mark this check-box if the person is a legal
entity.
Check-box “applicant only” (Box No. III): Mark this
check-box if the person named is a legal entity or if the person
named is not also inventor.
Check-box “inventor only” (Box No. III): Mark this checkbox if the person named is inventor but not also applicant.
This would be the case, for example, where the inventor is
deceased or has assigned the invention and the assignee is the
applicant for all designated States. Do not mark this checkbox if the person is a legal entity.
In Box No. III, one of the three check-boxes must always
be marked for each person named.

CONFIRMATION COPY
OF THE REQUEST FORM

A person must not be named more than once in Boxes Nos. II
and III, even where that person is both applicant and inventor.

Where the international application was initially filed by
facsimile with a receiving Office that accepts such filings (see
the PCT Applicant’s Guide, Annex C) this should be indicated
on the first sheet of the form by the annotation
“CONFIRMATION COPY” followed by the date of the
facsimile transmission.

Different Applicants for Different Designated States
(Rules 4.5(d), 18.3 and 19.2): It is possible to indicate different
applicants for the purposes of different designated States. At
least one of all the applicants named must be a national or
resident of a PCT Contracting State for which the receiving
Office acts, irrespective of the designated State(s) for the
purposes of which that applicant is named.

APPLICANT’S OR AGENT’S FILE REFERENCE
A File Reference may be indicated, if desired. It should not
exceed 12 characters. Characters in excess of 12 may be
disregarded by the receiving Office or any International
Authority (Rule 11.6(f) and Section 109).
BOX No. I
Title of Invention (Rules 4.3 and 5.1(a)): The title must be
short (preferably two to seven words when in English or
translated into English) and precise. It must be identical with
the title heading the description.

For the indication of the designated States for which a
person is applicant, mark the applicable check-box (only one
for each person). If the person is not an applicant for all
designated States, the check-box “the States indicated in the
Supplemental Box” must be marked, and the name of the
person must be repeated in the Supplemental Box with an
indication of the States for which that person is applicant (see
item 1(ii) in that Box).
Naming of Inventor (Rule 4.1(a)(iv) and (c)(i)): It is
strongly recommended to always name the inventor since such
information is generally required in the national phase. For
details, see the PCT Applicant’s Guide, Annex B.

BOXES Nos. II AND III
General: At least one of the applicants named must be a
resident or national of a PCT Contracting State for which the
receiving Office acts (Articles 9 and 11(1)(i) and Rules 18
and 19). If the international application is filed with the
International Bureau under Rule 19.1(a)(iii), at least one of the
applicants must be a resident or national of any PCT
Contracting State.
Indication Whether a Person is Applicant and/or Inventor
(Rules 4.5(a) and 4.6(a) and (b)):
Check-box “This person is also inventor” (Box No. II):
Mark this check-box if the applicant named is also the inventor
or one of the inventors; do not mark this check-box if the
applicant is a legal entity.

Different Inventors for Different Designated States
(Rule 4.6(c)): Different persons may be indicated as inventors
for different designated States (for example, where, in this
respect, the requirements of the national laws of the designated
States are not the same); in such a case, the Supplemental Box
must be used (see item 1(iii) in that Box). In the absence of
any indication, it will be assumed that the inventor(s) named is
(are) inventor(s) for all designated States.
Names and Addresses (Rule 4.4): The family name
(preferably in capital letters) must be indicated before the
given name(s). Titles and academic degrees must be omitted.
Names of legal entities must be indicated by their full
official designations.

Notes to the request form (PCT/RO/101) (page 1) (16 September 2012)

page 2

The address must be indicated in such a way that it allows
prompt postal delivery; it must consist of all the relevant
administrative units (up to and including the indication of the
house number, if any), the postal code (if any), and the name of
the country.
Only one address may be indicated per person. For the
indication of a special “address for correspondence”, see the
notes to Box No. IV.
Telephone, Facsimile Numbers and/or E-mail Addresses
should be indicated for the persons named in Boxes Nos. II
and IV in order to allow rapid communication with them (see
Rule 4.4(c)). Any telephone or facsimile number should include
the applicable country and area codes. A single e-mail address
only should be indicated.
Unless one of the applicable check-boxes is marked, any
e-mail address supplied will be used only for the types of
communication which might be made by telephone. If one of
the applicable check-boxes is marked, the receiving Office, the
International Searching Authority, the International Bureau and
the International Preliminary Examining Authority may send
notifications in respect of the international application to the
applicant, avoiding processing or postal delays. Note that not all
Offices will send such notifications by e-mail, (for details about
each Office’s procedure see the PCT Applicant’s Guide,
Annex B). If the first check-box is marked, any such e-mail
notification will always be followed by the official notification
on paper. Only that paper copy of the notification is considered
the legal copy of the notification and only the date of mailing of
that paper copy will commence any time limit within the
meaning of Rule 80. If the second check-box is marked, the
applicant requests the discontinuation of the sending of paper
copies of notifications and acknowledges that the date of
mailing indicated on the electronic copy will commence any
time limit within the meaning of Rule 80.
Note that it is the applicant’s responsibility to keep any e-mail
address details up-to-date and to ensure that incoming e-mails
are not blocked for any reason on the recipient’s side. Changes
to the e-mail address indicated in the request should be requested
to be recorded, preferably directly at the International Bureau,
under Rule 92bis. Where the e-mail authorization is given both
in respect of the applicant and in respect of an agent or common
representative, the International Bureau will send e-mail
communications only to the appointed agent or common
representative.
Applicant’s Registration Number with the Office
(Rule 4.5(e)): Where the applicant is registered with the
national or regional Office acting as receiving Office, the
request may indicate the number or other indication under
which the applicant is so registered.
Nationality (Rules 4.5(a) and (b) and 18.1): For each
applicant, the nationality must be indicated by the name or twoletter code of the State (that is, country) of which the person is
a national. A legal entity constituted according to the national
law of a State is considered a national of that State. The
indication of the nationality is not required where a person is
inventor only.
Residence (Rules 4.5(a) and (c) and 18.1): For each
applicant, the residence must be indicated by the name or twoletter code of the State (that is, country) of which the person is
a resident. If the State of residence is not indicated, it will be
assumed to be the same as the State indicated in the address.
Possession of a real and effective industrial or commercial
establishment in a State is considered residence in that State.
The indication of the residence is not required where a person is
inventor only.
Names of States (Section 115): For the indication of
names of States, the two-letter codes appearing in WIPO
Standard ST.3 and in the PCT Applicant’s Guide, Annex K,
may be used.

BOX No. IV
Who Can Act as Agent? (Article 49 and Rule 83.1bis):
For each of the receiving Offices, information as to who can act
as agent is given in the PCT Applicant’s Guide, Annex C.
Agent or Common Representative (Rules 4.7, 4.8, 90.1
and 90.2 and Section 108): Mark the applicable check-box in
order to indicate whether the person named is (or has been)
appointed as “agent” or “common representative” (the
“common representative” must be one of the applicants). For
the manner in which name(s), address(es) (including names of
States), telephone, facsimile numbers and/or e-mail addresses
must be indicated, see the notes to Boxes Nos. II and III. Where
several agents are listed, the agent to whom correspondence
should be addressed is to be listed first. If there are two or more
applicants but no common agent is appointed to represent all of
them, one of the applicants who is a national or resident of a
PCT Contracting State may be appointed by the other applicants
as their common representative. If this is not done, the applicant
first named in the request who is entitled to file an international
application with the receiving Office concerned will be
considered to be the common representative.
Manner of Appointment of Agent or Common
Representative (Rules 90.4 and 90.5 and Section 106): The
appointment of an agent or a common representative may be
effected by designating the agent or common representative in
Box No. IV and by the applicant signing the request or a
separate power of attorney. Where there are two or more
applicants, the appointment of a common agent or common
representative must be effected by each applicant signing, at
his choice, the request or a separate power of attorney. If the
separate power of attorney is not signed, or if the required
separate power of attorney is missing, or if the indication of the
name or address of the appointed person does not comply with
Rule 4.4, the power of attorney will be considered non-existent
unless the defect is corrected. However, the receiving Office
may waive the requirement that a separate power of attorney be
submitted to it (for details about each receiving Office, see the
PCT Applicant’s Guide, Annex C).
Where a general power of attorney has been filed and is
referred to in the request, a copy thereof must be attached to the
request. Any applicant who did not sign the general power of
attorney must sign either the request or a separate power of
attorney, unless the receiving Office has waived the requirement
that a separate power of attorney be submitted to it (for details,
see the PCT Applicant’s Guide, Annex C).
Agent’s Registration Number with the Office (Rule 4.7(b)):
Where the agent is registered with the national or regional
Office that is acting as receiving Office, the request may
indicate the number or other indication under which the agent
is so registered.
Address for Correspondence (Rule 4.4(d) and
Section 108): Where an agent is appointed, any correspondence
intended for the applicant will be sent to the address indicated
for that agent (or for the first-mentioned agent, if more than one
is appointed). Where one of two or more applicants is appointed
as common representative, the address indicated for that
applicant in Box No. IV will be used.
Where no agent or common representative is appointed, any
correspondence will be sent to the address, indicated in
Box No. II or III, of the applicant (if only one person is named
as applicant) or of the applicant who is considered to be
common representative (if there are two or more persons named
as applicants). However, if the applicant wishes
correspondence to be sent to a different address in such a case,
that address must be indicated in Box No. IV instead of the
designation of an agent or common representative. In this case,
and only in this case, the last check-box of Box No. IV must be
marked (that is, the last check-box must not be marked if either
of the check-boxes “agent” or “common representative” has
been marked).

Notes to the request form (PCT/RO/101) (page 2) (16 September 2012)

page 3

Telephone, Facsimile Numbers and/or E-mail Addresses
See Notes to Boxes Nos II and III.
BOX No. V
Designations (Regional and national patents) (Rule 4.9):
Upon filing of the request, the applicant will obtain an automatic and all-inclusive coverage of all designations available
under the PCT on the international filing date, in respect of
every kind of protection available and, where applicable, in
respect of both regional and national patents. If the applicant
wishes the international application to be treated, in a certain
designated or elected State, as an application not for a patent but
for another kind of protection available under the national law
of the designated or elected State concerned, the applicant will
have to indicate his choice directly to the designated or elected
Office when performing the acts, referred to in Articles 22
or 39(1), for entry into the national phase. For details about
various kinds of protection available in designated or elected
States, see the PCT Applicant’s Guide, Annex B.
However, for the reasons explained below, it is possible to
indicate, by marking the applicable check-box(es), that DE
Germany, JP Japan and/or KR Republic of Korea are not
designated for any kind of national protection. Each of those
States has notified the International Bureau that Rule 4.9(b)
applies to it since its national law provides that the filing of an
international application which contains the designation of that
State and claims the priority, at the time of filing or subsequently
under Rule 26bis.1, of an earlier national application (for DE:
for the same kind of protection) having effect in that State shall
have the result that the earlier national application ceases, where
applicable, after the expiration of certain time limits, to have
effect with the same consequences as the withdrawal of the
earlier national application. The designation of DE Germany
for the purposes of a EP European patent is not affected by what
is said above. For details see the PCT Applicant’s Guide, in the
relevant Annex B.
Only the three States mentioned above may be excluded from
the all-inclusive coverage of all designations in Box No. V. For
any other PCT Contracting State which the applicant wishes to
exclude from the all-inclusive coverage of all designations, the
applicant should submit a separate notice of withdrawal of the
designation concerned under Rule 90bis.2. Important: Should
a notice of withdrawal be filed, that notice will have to be
signed by the applicant or, if there are two or more applicants, by all of them (Rule 90bis.5(a)), or by an agent or a
common representative whose appointment has been effected by each applicant signing, at his choice, the request,
the demand or a separate power of attorney (Rule 90.4(a)).
BOX No. VI
Priority Claim(s) (Rule 4.10): If the priority of an earlier
application is claimed, the declaration containing the priority
claim must be made in the request.
The request must indicate the date on which the earlier
application from which priority is claimed was filed and the
number it was assigned. Note that that date must fall within the
period of 12 months preceding the international filing date.
Where the earlier application is a national application, the
country party to the Paris Convention for the Protection of
Industrial Property, or the Member of the World Trade
Organization that is not a party to that Convention, in which
that earlier application was filed must be indicated. Where the
earlier application is a regional application, the regional Office
concerned must be indicated. Where the earlier application is
an international application, the receiving Office with which
that earlier application was filed must be indicated.
Where the earlier application is a regional application (see
however below), or an international application, the priority
claim may also, if the applicant so wishes, indicate one or more
countries party to the Paris Convention for which that earlier

application was filed (Rule 4.10(b)(i)); such an indication is
not, however, mandatory. Where the earlier application is a
regional application and at least one of the countries party to
the regional patent treaty is neither party to the Paris Convention
nor a Member of the World Trade Organization, at least one
country party to the Paris Convention or one Member of the
World Trade Organization for which that earlier application
was filed must be indicated (Rule 4.10(b)(ii)) in the
Supplemental Box.
As to the possibility of correcting or adding a priority claim,
see Rule 26bis.1 and the PCT Applicant’s Guide, International
Phase.
Restoration of the Right of Priority (Rules 4.1(c)(v)
and 26bis.3): The procedure for restoration of the right of
priority is not applicable to a receiving Office which has
provided notice to the International Bureau under Rule 26bis.3(j)
of the incompatibility of Rule 26bis.3(a) to (i) with the national
law applied by that Office. Where the international application
is filed on a date which is later than the date on which the
priority period (see Rule 2.4) expired but within the period of
two months from that date, the applicant may request the
receiving Office to restore the right of priority (Rule 26bis.3).
Such a request must be filed with the receiving Office within
two months from the date on which the priority period expired;
it may be included in the request (Rule 4.1(c)(v)) by identifying
the priority claim(s) in Box No. VI. If, in Box No. VI, a priority
claim is identified in respect of which a request to restore the
right of priority is made, in such case, a separate document
should be submitted entitled “Statement for Restoration of the
Right of Priority”. This separate document should indicate, for
each earlier application concerned, the filing date, the earlier
application number and the name or two-letter code of the
country, Member of WTO, regional Office or receiving Office.
Then, for each earlier application concerned, the applicant
should state the reasons for the failure to file the international
application within the priority period (Rules 26bis.3(a) and
26bis.3(b)(ii)). Note that such a request may be subjected by
the receiving Office to the payment to it of a fee, payable within
the time limit referred to above (Rule 26bis.3(e)). According
to Rule 26bis.3(d), the time limit for payment of the fee may be
extended, at the option of the receiving Office, for a period of
up to two months from the expiration of the time limit applicable
under Rule 26bis.3(e). Note further that the receiving Office
may require the furnishing, within a reasonable time limit, of a
declaration or other evidence in support of the statement of
reasons; preferably, such declaration or other evidence should
already be submitted to the receiving Office together with the
request for restoration (Rule 26bis.3(b) and (f)). The receiving
Office shall restore the right of priority if it finds that a criterion
for restoration applied by the Office is satisfied
(Rule 26bis.3(a)). For information on which criteria a receiving
Office applies see the PCT Applicant’s Guide, Annex C.
Incorporation by Reference (Rules 4.18 and 20): The
procedure for incorporation by reference is not applicable to a
receiving Office which has provided notice to the International
Bureau under Rule 20.8(a) of the incompatibility of
Rules 20.3(a)(ii) and (b)(ii), 20.5(a)(ii) and (d), and 20.6 with
the national law applied by that Office. Where the receiving
Office finds that any of the requirements of Article 11(1)(iii)(d)
and (e) are not or appear not to be fulfilled, it will invite the
applicant to either furnish the required correction or confirm
that the element concerned referred to in Article 11(1)(iii)(d)
or (e) is incorporated by reference under Rule 4.18. Where the
applicant furnishes the required correction under Article 11(2),
the international filing date will be the date on which the
receiving Office receives the required correction (see
Rule 20.3(a)(ii) and (b)(i)), provided that all other requirements
of Article 11(1) are fulfilled. However, where the applicant
confirms the incorporation by reference of an element referred
to in Article 11(1)(iii)(d) or (e) which is completely contained
in an earlier application the priority of which is claimed in the
international application, that element will be considered to
have been contained in the purported international application
on the date on which one or more elements referred to in

Notes to the request form (PCT/RO/101) (page 3) (16 September 2012)

page 4

Article 11(1)(iii) were first received by the receiving Office,
and the international filing date will be the date on which all
Article 11(1) requirements are fulfilled (see Rule 20.3(a)(ii)
and (b)(ii)).
Where the applicant furnishes a missing part to the receiving
Office after the date on which all of the requirements of
Article 11(1) were fulfilled but within the applicable time limit
under Rule 20.7, that part will be included in the international
application and the international filing date will be corrected to
the date on which the receiving Office received that part (see
Rule 20.5(c)). In such a case, the applicant will be given the
opportunity to request the receiving Office to disregard the
missing part concerned, in which case the missing part would
be considered not to have been furnished and the correction of
the international filing date not to have been made (see
Rule 20.5(e)). However, where the applicant confirms the
incorporation by reference of a part of the description, claims
or drawings under Rule 4.18 and the receiving Office finds that
all the requirements of Rules 4.18 and 20.6(a) are complied
with, that part will be considered to have been contained in the
purported international application on the date on which one or
more elements referred to in Article 11(1)(iii) were first received
by the receiving Office, and the international filing date will be
the date on which all of the requirements of Article 11(1) are
fulfilled (see Rule 20.5).
Furnishing the priority document(s) (Rule 17.1): A
certified copy of each earlier application the priority of which
is claimed (priority document) must be submitted by the
applicant, irrespective of whether that earlier application is a
national, regional or international application. The priority
document must be submitted to the receiving Office or to the
International Bureau before the expiration of 16 months from
the (earliest) priority date or, where an early start of the national
phase is requested, not later than at the time such request is
made. Any priority document received by the International
Bureau after the expiration of the 16-month time limit but
before the date of international publication shall be considered
to have been received on the last day of that time limit
(Rule 17.1(a)).
Where the priority document was issued by the receiving
Office, the applicant may, instead of submitting the priority
document, request the receiving Office (not later than 16
months after the priority date) to prepare and transmit the
priority document to the International Bureau (Rule 4.1(c)(ii)).
Such requests may be made by marking the applicable checkboxes in Box No. VI. Note that where such a request is made,
the applicant must, where applicable, pay to the receiving
Office the fee for priority document, otherwise, the request will
be considered not to have been made (see Rule 17.1(b)).
Where the priority document is available from an Office that
participates in the WIPO Digital Access Service for Priority
Documents (DAS) (www.wipo.int/patentscope/en/
priority_documents/offices.html), the applicant may use DAS
to provide the priority document to the International Bureau.
Once the applicant requests the depositing Office to provide a
copy of the priority document to DAS (see PCT Applicant’s
Guide, Annex B of the DAS depositing Office for further
indications of the procedure to be followed), the applicant will
receive an access code. The applicant should then mark the
applicable check-boxes in Box No. VI, and indicate the access
code for each specific priority document. (For a transitional
period, until all DAS accessing offices are using the system
described above, the old system will continue to work, where
the check-box to request retrieval from DAS can be selected
without indicating the access code, as long as the applicant
allows access to the priority document for the International
Bureau using the access control list in the DAS applicant
portal.)
Information concerning whether and which priority
documents are available to the International Bureau from a
digital library is published in the Official Notices (PCT Gazette)
pursuant to Section 715(c) and the PCT Applicant’s Guide,
Annex B(IB).

Dates (Section 110): Dates must be indicated by the Arabic
number of the day, the name of the month and the Arabic
number of the year – in that order; after, below or above such
indication, the date should be repeated in parentheses, using
two-digit Arabic numerals each for the number of the day and
for the number of the month followed by the number of the year
in four digits, in that order and separated by periods, slants or
hyphens, for example, “26 October 2012 (26.10.2012)”,
“26 October 2012 (26/10/2012)” or “26 October 2012
(26-10-2012)”.
BOX No. VII
Choice of International Searching Authority (ISA)
(Rules 4.1(b)(iv) and 4.14bis): If two or more International
Searching Authorities are competent for carrying out the
international search in relation to the international application –
depending on the language in which that application is filed
and the receiving Office with which it is filed – the name of the
competent Authority chosen by the applicant must be indicated
in the space provided, either by its full name or two-letter code.
Request to Use Results of Earlier Search; Reference to
that Search (Rules 4.12, 12bis, 16.3 and 41.1). The applicant
may request the ISA to take into account, in carrying out the
international search, the results of an earlier search carried out
either by that Authority, by another ISA or by a national Office
(Rule 4.12). Where the applicant has made such a request and
complied with the requirements under Rule 12bis, the ISA
shall, to the extent possible, take into account the results of the
earlier search. If, on the other hand, the earlier search was
carried out by another ISA or by another national or regional
Office, the ISA may, but is not obliged to, take the results of the
earlier search into account (Rule 41.1). Where the ISA takes
into account the results of an earlier search, it shall (partially)
refund the search fee to the extent and under the conditions
provided for in the agreement under Article 16(3)(b) (see, for
each ISA, the PCT Applicant’s Guide, Annex D).
Any request to take into account the results of an earlier
search should identify: the filing date and number of the
application in respect of which the earlier search was carried out
and the Authority or Office which carried out the earlier search
(Rules 4.1(b)(ii) and 4.12(i)).
The applicant shall submit to the receiving Office, together
with the international application at the time of filing, a copy of
the results of the earlier search (Rule 12bis.1(a)), except:
– where the earlier search was carried out by the same Office
as that which is acting as the receiving Office, the applicant
may, instead of submitting copies of the required documents,
request the receiving Office to transmit copies of those
documents to the ISA by marking the appropriate check-box
(Rule 12bis.1(c));
– where the earlier search was carried out by the same Authority
or Office as that which is acting as ISA, no copy or translation
of any document (i.e. of the results of the earlier search or of the
earlier application or of any document cited in the earlier search,
where applicable) is required to be submitted (Rule 12bis.1(d));
– where a copy or translation of the earlier search is available
to the ISA in a form and manner acceptable to it, and if so
indicated in the request form by the applicant by marking the
appropriate check-box, no copy or translation of any document
is required to be submitted to the ISA (Rule 12bis.1(f));
– where the request form contains a statement under
Rule 4.12(ii) that the international application is the same, or
substantially the same, as an application in respect of which the
earlier search was carried out, or that the international application
is the same, or substantially the same, as that earlier application,
except that it is filed in a different language, no copy of the
earlier application or its translation is required to be transmitted
to the ISA (Rules 4.12(ii) and 12bis.1(e)).

Notes to the request form (PCT/RO/101) (page 4) (16 September 2012)

page 5

Use of Results of more than one Earlier Search: Where
the ISA is requested to use the results of more than one earlier
search, the check-boxes in Box No. VII should be marked, as
applicable, for each earlier search. Where more than two results
of previous searches are indicated, please mark the relevant
check-box, and furnish duplicates of this page, marked
“continuation sheet for Box No. VII” and attached to the request
form.

Offices are therefore entitled to require further documents or
evidence on the matters to which those declarations relate. For
regularly updated information on such Offices, see the WIPO
website:
www.wipo.int/pct/en/texts/reservations/
res_incomp.html.

BOX No. VIII

Different Declaration Boxes: There are six different
declaration boxes in the pre-printed request form – one box for
each of the five different types of declarations provided for in
Rule 4.17 (Box No. VIII (i) to Box No. VIII (v)) and a
continuation sheet (Continuation of Box No. VIII (i) to (v)) to
be used in case any single declaration does not fit in the
corresponding box. The title of each type of declaration which
is found in the standardized wording provided for in the
Administrative Instructions is pre-printed on the appropriate
sheet of the request.

Declarations Containing Standardized Wording
(Rules 4.1(c)(iii) and 4.17): At the option of the applicant, the
request may, for the purposes of the national law applicable in
one or more designated States, contain one or more of the
following declarations:
(i) declaration as to the identity of the inventor;
(ii) declaration as to the applicant’s entitlement, as at the
international filing date, to apply for and be granted a
patent;
(iii) declaration as to the applicant’s entitlement, as at the
international filing date, to claim the priority of the
earlier application;
(iv) declaration of inventorship (only for the purposes of the
designation of the United States of America);
(v) declaration as to non-prejudicial disclosures or
exceptions to lack of novelty;
which must conform to the standardized wording provided for
in Sections 211 to 215, respectively, and which must be set
forth in Boxes Nos. VIII (i) to (v), as detailed below. Where
any such declarations are included, the appropriate checkboxes in Box No. VIII should be marked and the number of
each type of declaration should be indicated in the right-hand
column. As to the possibility of correcting or adding a
declaration, see Rule 26ter, Section 216 and the PCT Applicant’s
Guide, International Phase.
If the circumstances of a particular case are such that the
standardized wordings are not applicable, the applicant should
not attempt to make use of the declarations provided for in
Rule 4.17 but rather will have to comply with the national
requirements concerned upon entry into the national phase.
The fact that a declaration is made under Rule 4.17 does not
of itself establish the matters declared; the effect of those
matters in the designated States concerned will be determined
by the designated Offices in accordance with the applicable
national law.
Even if the wording of a declaration does not conform to the
standardized wording provided for in the Administrative
Instructions pursuant to Rule 4.17, any designated Office may
accept that declaration for the purposes of the applicable national
law, but is not required to do so.
Details as to National Law Requirements: For information
on the declarations required by each designated Office, see the
PCT Applicant’s Guide, in the relevant National Chapter.

BOXES Nos. VIII (i) TO (v)
(IN GENERAL)

Separate Sheet for Each Declaration: Each declaration
must start on a separate sheet of the request form in the
appropriate Declaration Box.
Titles, Items, Item Numbers, Dotted Lines, Words in
Parentheses and Words in Brackets: The prescribed
standardized wording of the declarations includes titles, various
items, item numbers, dotted lines, words in parentheses and
words in brackets. Except for Box No. VIII (iv) which contains
the pre-printed standardized wording, only those items which
are applicable should be included in a declaration where
necessary to support the statements in that declaration (that
is, omit those items which do not apply) and item numbers
need not be included. Dotted lines indicate where information
is required to be inserted. Words in parentheses are
instructions to applicants as to the information which may
be included in the declaration depending upon the factual
circumstances. Words in brackets are optional and should
appear in the declaration without the brackets if they apply;
if they do not apply, they should be omitted together with
the corresponding brackets.
Naming of Several Persons: More than one person may be
named in a single declaration. In the alternative, with one
exception, a separate declaration may be made for each person.
With respect to the declaration of inventorship set forth in
Box No. VIII (iv), which is applicable only for the purposes of
the designation of the United States of America, all inventors
must be indicated in a single declaration (see Notes to
Box No. VIII (iv), below). The wording of declarations to be
set forth in Boxes Nos. VIII (i), (ii), (iii) and (v) may be adapted
from the singular to the plural as necessary.
BOX No. VIII (i)
Declaration as to the Identity of the Inventor (Rule 4.17(i)
and Section 211): The declaration must be worded as follows:
“Declaration as to the identity of the inventor (Rules 4.17(i)
and 51bis.1(a)(i)):
in relation to [this] international application [No. PCT/…],

Effect in Designated Offices (Rule 51bis.2): Where the
applicant submits any of the declarations provided for in
Rule 4.17(i) to (iv) containing the required standardized wording
(either with the international application, or to the International
Bureau within the relevant time limit under Rule 26ter, or
directly to the designated Office during the national phase), the
designated Office may not, in the national phase, require further
documents or evidence on the matter to which the declaration
relates, unless that designated Office may reasonably doubt the
veracity of the declaration concerned.
Incompatibility of Certain Items of Rule 51bis.2(a) with
National Laws (Rule 51bis.2(c)): Certain designated Offices
have informed the International Bureau that the applicable
national law is not compatible in respect of certain declarations
provided in Rule 4.17(i), (ii) and (iii). Those designated
Notes to the request form (PCT/RO/101) (page 5) (16 September 2012)

... (name) of … (address) is the inventor of the
subject matter for which protection is sought by way
of [the] [this] international application”
Such a declaration is not necessary in respect of any inventor
who is indicated as such (either as inventor only or applicant
and inventor) in Box No. II or No. III in accordance with
Rule 4.5 or 4.6. However, where the inventor is indicated as
applicant in Box No. II or No. III in accordance with Rule 4.5,
a declaration as to the applicant’s entitlement to apply for and
be granted a patent (Rule 4.17(ii)) may be appropriate. Where
indications regarding the inventor in accordance with Rule 4.5
or 4.6 are not included in Box No. II or No. III, this declaration
may be combined with the prescribed wording of the declaration
as to the applicant’s entitlement to apply for and be granted a

page 6

patent (Rule 4.17(ii)). For details on such a combined
declaration, see Notes to Box No. VIII (ii), below. For details
as to the declaration of inventorship for the purposes of the
designation of the United States of America, see Notes to
Box No. VIII (iv), below.
BOX No. VIII (ii)
Declaration as to the Applicant’s Entitlement to Apply
for and Be Granted a Patent (Rule 4.17(ii) and Section 212):
The declaration must be worded as follows, with such inclusion,
omission, repetition and re-ordering of the matters listed as
items (i) to (viii) as is necessary to explain the applicant’s
entitlement:
“Declaration as to the applicant’s entitlement, as at the
international filing date, to apply for and be granted a patent
(Rules 4.17(ii) and 51bis.1(a)(ii)), in a case where the
declaration under Rule 4.17(iv) is not appropriate:
in relation to [this] international application [No. PCT/…],
... (name) is entitled to apply for and be granted a patent by
virtue of the following:
(i) ... (name) of … (address) is the inventor of the
subject matter for which protection is sought by way
of [the] [this] international application
(ii) ... (name) [is] [was] entitled as employer of the
inventor, ... (inventor’s name)
(iii) an agreement between … (name) and … (name),
dated …
(iv) an assignment from … (name) to … (name), dated …
(v) consent from … (name) in favor of … (name), dated …
(vi) a court order issued by … (name of court), effecting
a transfer from … (name) to … (name), dated …
(vii) transfer of entitlement from … (name) to … (name)
by way of … (specify kind of transfer), dated …
(viii) the applicant’s name changed from … (name) to …
(name) on … (date)”
Items (i) to (viii) may be incorporated as is necessary to
explain the applicant’s entitlement. This declaration is only
applicable to those events which have occurred prior to the
international filing date. The possible kinds of transfer of
entitlement in item (vii) include merger, acquisition, inheritance,
donation, etc. Where there has been a succession of transfers
from the inventor, the order in which transfers are listed
should follow the actual succession of transfers, and items
may be included more than once, as necessary to explain the
applicant’s entitlement. Where the inventor is not indicated in
Box No. II or No. III, this declaration may be presented as a
combined declaration explaining the applicant’s entitlement
to apply for and be granted a patent and identifying the
inventor. In such a case, the introductory phrase of the
declaration must be as follows:
“Combined declaration as to the applicant’s entitlement, as
at the international filing date, to apply for and be granted a
patent (Rules 4.17(ii) and 51bis.1(a)(ii)) and as to the identity
of the inventor (Rules 4.17(i) and 51bis.1(a)(i)), in a case
where the declaration under Rule 4.17(iv) is not appropriate:”
The remainder of the combined declaration must be worded
as indicated in the preceeding paragraphs.
For details as to the declaration as to the identity of the
inventor, see the Notes to Box No. VIII (i), above.
BOX No. VIII (iii)
Declaration as to the Applicant’s Entitlement to Claim
Priority of the Earlier Application (Rule 4.17(iii) and
Section 213): The declaration must be worded as follows,

with such inclusion, omission, repetition and re-ordering of the
matters listed as items (i) to (viii) as is necessary to explain the
applicant’s entitlement:
“Declaration as to the applicant’s entitlement, as at the
international filing date, to claim the priority of the earlier
application specified below, where the applicant is not the
applicant who filed the earlier application or where the
applicant’s name has changed since the filing of the earlier
application (Rules 4.17(iii) and 51bis.1(a)(iii)):
in relation to [this] international application [No. PCT/…],
… (name) is entitled to claim priority of earlier application
No. … by virtue of the following:
(i) the applicant is the inventor of the subject matter for
which protection was sought by way of the earlier
application
(ii) … (name) [is] [was] entitled as employer of the
inventor, … (inventor’s name)
(iii) an agreement between … (name) and … (name),
dated …
(iv) an assignment from … (name) to … (name), dated …
(v) consent from … (name) in favor of … (name), dated …
(vi) a court order, issued by … (name of court), effecting a
transfer from … (name) to … (name), dated …
(vii) transfer of entitlement from … (name) to … (name) by
way of … (specify kind of transfer), dated …
(viii) the applicant’s name changed from … (name)
to … (name) on … (date)”
Items (i) to (viii) may be incorporated as is necessary to
explain the applicant’s entitlement. This declaration is only
applicable to those events which have occurred prior to the
international filing date. In addition, this declaration is only
applicable where the person or name of the applicant is different
from that of the applicant who filed the earlier application from
which priority is claimed. For example, this declaration may be
applicable where only one applicant out of five is different
from the applicants indicated in respect of an earlier application.
The possible kinds of transfer of entitlement in item (vii)
include merger, acquisition, inheritance, donation, etc. Where
there has been a succession of transfers from the applicant in
respect of the earlier application, the order in which transfers
are listed should follow the actual succession of transfers, and
items may be included more than once, as necessary to explain
the applicant’s entitlement.
BOX No. VIII (iv)
Declaration of Inventorship (Rule 4.17(iv) and
Section 214): The standardized wording for the declaration is
pre-printed in Box No. VIII (iv).
The name, residence and address must be included for each
inventor. If the name and address of an inventor is not written
in the Latin alphabet, the name and address must be indicated in
the Latin alphabet. All inventors must sign and date the
declaration even if they do not all sign the same copy of the
declaration (Section 214(b)).
If there are more than three inventors, those other inventors
must be indicated on the “Continuation of Box No. VIII (i)
to (v)” sheet. The continuation sheet should be entitled
“Continuation of Box No. VIII (iv),” must indicate the name,
residence and address for those other inventors, and at least the
name and address in the Latin alphabet. In such a case, the
“complete declaration” includes Box No. VIII (iv) and the
continuation sheet. All inventors must sign and date a complete
declaration even if they do not all sign the same copy of the
complete declaration, and a copy of each separately signed
complete declaration must be submitted (Section 214(b)).

Notes to the request form (PCT/RO/101) (page 6) (16 September 2012)

page 7

Where the declaration was not included in the request, but
is furnished later, the PCT application number MUST be
indicated within the text of Box No. VIII (iv).
BOX No. VIII (v)
Declaration as to Non-prejudicial Disclosures or
Exceptions to Lack of Novelty (Rule 4.17(v) and Section 215):
The declaration must be worded as follows, with such inclusion,
omission, repetition and re-ordering of the matters listed as
items (i) to (iv) as is necessary:
“Declaration as to non-prejudicial disclosures or exceptions
to lack of novelty (Rules 4.17(v) and 51bis.1(a)(v)):
in relation to [this] international application [No. PCT/…],
… (name) declares that the subject matter claimed in [the]
[this] international application was disclosed as follows:
(i) kind of disclosure (include as applicable):
(a) international exhibition
(b) publication
(c) abuse
(d) other: … (specify)
(ii) date of disclosure: …
(iii) title of disclosure (if applicable): …
(iv) place of disclosure (if applicable): …”
Either (a), (b), (c) or (d) of item (i) should always be
included in the declaration. Item (ii) should also always be
included in the declaration. Items (iii) and (iv) may be
incorporated depending upon the circumstances.
BOX No. IX
Sheets Constituting the International Application: The
number of sheets of the various parts of the international
application must be indicated in the check list using Arabic
numerals. Sheets containing any of the Boxes Nos. VIII(i) to (v)
(declaration sheets) must be counted as part of the request. It is
noted that any tables, including those related to a sequence
listing, should be an integral part of the description and the
pages containing such tables will be counted as sheets of the
international application. There is no longer any provision for
submission of those tables separately or a reduced fee for such
a submission.
Nucleotide and/or amino acid sequences: Paper Filings:
Where the international application is filed on paper (using the
sheet “last sheet - paper”) and contains disclosure of one of
more nucleotide and/or amino acid sequences, a sequence
listing must be presented as a separate part of the description
(“sequence listing part of description”) in accordance with the
standard contained in Annex C of the Administrative
Instructions, that is, in compliance with WIPO Standard ST.25.
The number of pages of the sequence listing must be indicated
under item (f) in Box No. IX and included in the total number
of sheets. Furthermore, where the sequence listing is filed on
paper, a copy of the sequence listing in the form of an Annex C/
ST.25 text file saved on physical data carrier(s) (together with
the required statement) should accompany the international
application, if so required by the ISA but only for the purposes
of international search under Rule 13ter. In such cases therefore,
check-boxes Nos. 8 and 9 must be marked in Box No. IX. In
addition, the type and number of carriers such as diskettes, CDROMs, CD-Rs or other data carriers accepted by the ISA,
should be indicated in item 8.
_________________________________________________
For EFS-Web filing with RO/US
Nucleotide and/or amino acid sequences: Electronic
Filings via EFS-Web with RO/US: There exist two alternative
last sheets of the request form which contain two distinct

Boxes No. IX. The sheet “last sheet – paper”, described earlier,
should be used if the applicant intends to file the international
application on paper. The sheet “last sheet – EFS” should only
be used if the request form is filed online with the receiving
Office of the United States of America via EFS-Web.
(a) EFS-Web and text file: Where the international
application is filed via EFS-Web (using the sheet “last sheet EFS”) and contains disclosure of one or more nucleotide and/
or amino acid sequences, a sequence listing must be presented
as a separate part of the description (“sequence listing part of
description”) in accordance with the standard contained in
Annex C of the Administrative Instructions, that is, in compliance
with WIPO Standard ST.25. The sequence listing should
preferably be furnished as an Annex C/ST.25 text file; in such
cases, the first check-box of check-box (g) in Box No. IX
should be marked. When furnished in this manner, the number
of sheets of the sequence listing is not included in the total
number of sheets making up the international application.
Whenever the sequence listing is furnished as an Annex C/
ST.25 text file, there is no need to file another copy of the text
file for search purposes under Rule 13ter since the text file
submitted will be used for both disclosure of the international
application and for search purposes.
(b) EFS-Web and image file: If the sequence listing is
filed online via EFS-Web as an image file (e.g. PDF file) rather
than the recommended text file, the corresponding boxes in
check-box (f) in Box No. IX should be marked. The number of
sheets of the sequence listing must be included in the total
number of sheets making up the international application.
Where the sequence listing is filed in image format, a copy of
the sequence listing in the form of an Annex C/ST.25 text file
(together with the required statement) should accompany the
international application, if so required by the ISA but only for
the purposes of international search under Rule 13ter. In such
cases, check-boxes Nos. 8 and 9 must be marked in Box No. IX.
(c) EFS-Web and physical data carriers: The receiving
Office of the United States of America has two distinct limitations
on the size of the sequence listing file it can accept via EFSWeb. If the text file containing the sequence listing is larger
than 100MB, or if the image file (e.g. PDF file) containing the
sequence listing is larger than 25MB, the applicant must file the
sequence listings as an Annex C/ST.25 text file on physical data
carrier(s). The receiving Office does not accept the filing of
image (e.g. PDF file) on physical data carrier(s). In such cases,
the data carrier(s) must be furnished on the same day that the
international application is filed online. This may be furnished
via “Express Mail Post Office to Addressee” with a date-in by
the United States Postal Service the same date as the online
filing date, or via commercial delivery services or by hand,
provided that it reaches the receiving Office on the same day as
the international application filed online. In such cases, the
corresponding check-boxes in check-box (g) in Box No. IX
must be marked. The number and type of carrier(s) should be
indicated in check-box (g). Whenever the sequence listing is
furnished as an Annex C/ST.25 text file, there is no need to file
another copy of the text file for search purposes under Rule 13ter
since the text file submitted will be used for both disclosure of
the international application and for search purposes.
__________________________________________________
Items Accompanying the International Application:
Where the international application is accompanied by certain
items, the applicable check-boxes must be marked, any
applicable indication must be made on the dotted line after the
applicable item, and the number of such items should be
indicated at the end of the relevant line; detailed explanations
are provided below only in respect of those items which so
require.
Check-box No. 4: Mark this check-box where a copy of a
general power of attorney is filed with the international application; where the general power of attorney has been deposited
with the receiving Office, and that Office has accorded to it a
reference number, that number may be indicated.

Notes to the request form (PCT/RO/101) (page 7) (16 September 2012)

page 8

Check-box No. 6: Mark this check-box where a translation
of the international application for the purposes of international
search (Rule 12.3) is filed together with the international
application and indicate the language of that translation.
Check-box No. 7: Mark this check-box where a filled-in
Form PCT/RO/134 or any separate sheet containing
indications concerning deposited microorganisms and/or other
biological material is filed with the international application.
If Form PCT/RO/134 or any sheet containing the said indications
is included as one of the sheets of the description (as required
by certain designated States (see the PCT Applicant’s Guide,
Annex L)), do not mark this check-box (for further information,
see Rule 13bis and Section 209).

power of attorney already in the possession of the receiving
Office, must be furnished. The power of attorney must be
signed by the applicant, or if there is more than one applicant,
by at least one of them. If the power is not filed with the
request, the receiving Office will invite the applicant to furnish
it, unless it has waived the requirement for a separate power of
attorney (for details about each receiving Office, see the PCT
Applicant’s Guide, Annex C).
SUPPLEMENTAL BOX
The cases in which the Supplemental Box may be used and
the manner of making indications in it are explained in the left
column of that Box.

Check-boxes Nos. 8 and 9: Where the sequence listing
part of the description is submitted on paper, a copy of the
sequence listing in the form of an Annex C/ST.25 text file
(together with the required statement) should accompany the
international application, if so required by the ISA, but only
for the purposes of international search under Rule 13ter. In
this case, check-boxes Nos. 8 and 9, must be marked in
Box No. IX.

Items 2 and 3: Even if an indication is made in respect of
items 2 and 3 under Rule 49bis.1(a), (b) or (d), the applicant
will be required to make an indication to this effect upon entry
into the national phase before the designated offices concerned.

Language of Filing of the International Application
(Rules 12.1(a) and 20.4(c) and (d)): With regard to the
language in which the international application is filed, for the
purposes of according an international filing date, it is, subject
to the following sentence, sufficient that the description and
the claims are in the language, or one of the languages,
accepted by the receiving Office for the filing of international
applications; that language should be indicated in that checkbox (as regards the language of the abstract and any text matter
in the drawings, see Rule 26.3ter(a) and (b); as regards the
language of the request, see Rules 12.1(c) and 26.3ter(c)
and (d)). Note that where the international application is filed
with the United States Patent and Trademark Office as receiving
Office, all elements of the international application (request,
description, claims, abstract, text matter of drawings) must, for
the purposes of according an international filing date, be in
English except that the free text in any sequence listing part of
the description, complying with the standard set out in Annex C
of the Administrative Instructions, may be in a language other
than English.

GENERAL REMARKS

If the applicant wishes to specify that the international
application be treated in any designated State as an application
for a utility model, see Notes to Box No. V.

Language of Correspondence (Rule 92.2 and
Section 104): Any letter from the applicant to the receiving
Office must be in the language of filing of the international
application provided that, where the international application
is to be published in the language of a translation required
under Rule 12.3, such letter should be in the language of that
translation; however, the receiving Office may authorize the
use of another language.
Any letter from the applicant to the International Bureau
must be in the same language as the international application if
that language is English or French; otherwise, it must be in
English or French, at the choice of the applicant.

BOX No. X

Any letter from the applicant to the ISA must be in the same
language as the international application, provided that, where
a translation of the international application for the purposes
of international search has been transmitted under Rule 23.1(b),
such letter is in the language of that translation. However, the
ISA may authorize the use of another language.

Signature (Rules 4.1(d), 4.15, 26.2bis(a), 51bis.1(a)(vi),
90 and 90bis.5): The signature must be that of the applicant;
if there are several applicants, all must sign. However, if the
signature of one or more of the applicants is missing, the
receiving Office will not invite the applicant to furnish the
missing signature(s) provided that at least one of the applicants
signed the request.

Arrangement of Elements and Numbering of Sheets of
the International Application (Rule 11.7 and Section 207):
The elements of the international application must be placed in
the following order: the request, the description (excluding
the sequence listing part, if any), the claim(s), the abstract, the
drawings (if any), the sequence listing part of the description
(if any).

Important: Should a notice of withdrawal be filed at
any time during the international phase, that notice will
have to be signed by the applicant or, if there are two or
more applicants by all of them (Rule 90bis.5(a)), or by an
agent or a common representative whose appointment has
been effected by each applicant signing, at his choice, the
request, the demand or a separate power of attorney
(Rule 90.4(a)).

All sheets of the description (excluding the sequence listing
part), claims and abstract must be numbered in consecutive
Arabic numerals, which must be placed at the top or bottom of
the sheet, in the middle, but not in the margin which must
remain blank. The number of each sheet of the drawings must
consist of two Arabic numerals separated by an oblique stroke,
the first being the sheet number and the second being the total
number of sheets of drawings (for example, 1/3, 2/3, 3/3). For
numbering of the sheets of the sequence listing part of the
description, see Section 207.

Furthermore, for the purposes of the national phase
processing, each designated Office will be entitled to require
the applicant to furnish the confirmation of the international
application by the signature of any applicant for the designated
State concerned, who has not signed the request.
Where the signature on the request is not that of the
applicant but that of the agent, or the common representative,
a separate power of attorney appointing the agent or the
common representative, respectively, or a copy of a general

Indication of the Applicant’s or Agent’s File Reference
on the sheets of the description (excluding the sequence listing
part, if any), claim(s), abstract, drawings and sequence listing
part of the description (Rule 11.6(f)): The file reference
indicated on the request may also be indicated in the left-hand
corner of the top margin, within 1.5 cm from the top of any
sheet of the international application.

Notes to the request form (PCT/RO/101) (page 8) (16 September 2012)

This sheet is not part of and does not count as a sheet of the international application.

PCT

For receiving Office use only

FEE CALCULATION SHEET
Annex to the Request

International Application No.

Applicant’s or agent’s
file reference

Date stamp of the receiving Office

Applicant

CALCULATION OF PRESCRIBED FEES
T

1. TRANSMITTAL FEE . . . . . . . . . . . . . . . . . . . . .

S

2. SEARCH FEE . . . . . . . . . . . . . . . . . . . . . . . .
International search to be carried out by
_________________________
(If two or more International Searching Authorities are competent to carry out the
international search, indicate the name of the Authority which is chosen to carry out
the international search.)
3. INTERNATIONAL FILING FEE
Enter total number of sheets indicated in Box No IX:

____________________

i1

i1 first 30 sheets . . . . . . . . . . . . . . . . .

i2

_________________
number of sheets
in excess of 30

i2

x __________________ =
fee per sheet

I

Add amounts entered at i1 and i2 and enter total at I . . . .
(Applicants from certain States are entitled to a reduction of 90% of the
international filing fee. Where the applicant is (or all applicants are) so
entitled, the total to be entered at I is 10% of the international filing fee.)

4. FEE FOR PRIORITY DOCUMENT (if applicable)

P

. . . . . . . . . .

5. FEE FOR RESTORATION OF THE RIGHT OF PRIORITY (if applicable) .

RP

6. FEE FOR EARLIER SEARCH DOCUMENTS (if applicable) . . . . . .

ES

7. TOTAL FEES PAYABLE . . . . . . . . . . . .
Add amounts entered at T, S, I, P, RP and ES,
and enter total in the TOTAL box

TOTAL

MODE OF PAYMENT (Not all modes of payment may be available at all receiving Offices)
authorization to charge deposit
or current account (see below)

postal money order

credit card (details should
be furnished separately and
not included on this sheet)

cash

check

bank transfer

revenue stamps

other (specify):

AUTHORIZATION TO CHARGE (OR CREDIT) DEPOSIT OR CURRENT ACCOUNT
(This mode of payment may not be available at all receiving Offices)
Receiving Office: RO/ __________________________
Authorization to charge the total fees indicated above.

Deposit or Current Account No.: __________________

(This check-box may be marked only if the conditions for deposit or current
accounts of the receiving Office so permit) Authorization to charge any
deficiency or credit any overpayment in the total fees indicated above.

Date: ________________________________________

Authorization to charge the fee for priority document.

Signature: ____________________________________

Form PCT/RO/101 (Annex) (16 September 2012)

Name: _______________________________________

See Notes to the fee calculation sheet

NOTES TO THE FEE CALCULATION SHEET
(ANNEX TO FORM PCT/RO/101)

The purpose of the fee calculation sheet is to help the applicant to identify the prescribed fees and to calculate the amounts to
be paid. It is strongly recommended that the applicant complete the sheet by entering the appropriate amounts in the boxes provided
and submit the fee calculation sheet at the time of filing the international application. This will help the receiving Office to verify
the calculations and to identify any error in them.
Information about the applicable fees payable can be obtained from the receiving Office. The amounts of the international filing
and search fees may change due to currency fluctuations. Applicants are advised to check what are the latest applicable amounts.
All fees, must be paid within one month from the date of receipt of the international application.

CALCULATION OF PRESCRIBED FEES
Box T: Transmittal Fee for the benefit of the receiving
Office (Rule 14.1): The amount of the transmittal fee, if any,
is fixed by the receiving Office. It must be paid within one
month from the date of receipt of the international application
by the receiving Office. Information about this fee is contained
in the PCT Applicant’s Guide, Annex C.
Box S: Search Fee for the benefit of the International
Searching Authority (ISA) (Rule 16.1): The amount of the
search fee is fixed by the ISA. It must be paid within one month
from the date of receipt of the international application by the
receiving Office. Information about this fee is contained in the
PCT Applicant’s Guide, Annex D.
Where two or more ISAs are competent, the applicant must
indicate his choice in the space provided for this purpose and
pay the amount of the international search fee fixed by the ISA
chosen. Information on the competent ISA and whether the
applicant has a choice between two or more ISAs is contained
in the PCT Applicant’s Guide, Annex C.
Box I: International Filing Fee: The amount of the
international filing fee depends on the number of sheets of the
international application indicated in Box No. IX of the request
as explained below.
That number is the Total number of sheets indicated in
Box No. IX of the request, which includes the actual number of
sheets of the sequence listing part of the description, if the
listing is filed on paper and not as an Annex C/ST.25 text file.
________________________________________________________
For EFS-Web filing with RO/US
Nucleotide and/or amino acid sequences: via EFS-Web:
Where the international application is filed via EFS-Web and
contains a sequence listing filed in an Annex C/ST.25 text file,
even when, due to the size of the text file, the sequence listing
has to be submitted on a data carrier, no fee is due for filing the
sequence listing.
Where the sequences listing is an image file (e.g. PDF) the
actual number of sheets that make up this part of the description
must be included.
__________________________________________________
The international filing fee must be paid within one month
from the date of receipt of the international application by the
receiving Office.
Reduction of the International Filing Fee Where PCTSAFE Software Is Used in PCT-EASY Mode: A fee reduction
of 100 Swiss francs (or the equivalent in the currency in which
the international filing fee is paid to the receiving Office) is
available in certain cases where the PCT-SAFE software is
used to prepare the request, provided that the necessary
conditions are met. For further details, see the PCT Applicant’s
Guide, International Phase and Annex C, as well as information

published in the Official Notices (PCT Gazette) and the PCT
Newsletter. Since applicants using the PCT-SAFE software
will file the Request Form and Fee Calculation Sheet in the
form of a printout prepared using that software in PCT-EASY
mode, no provision is made for this fee reduction in the Fee
Calculation Sheet annexed to Form PCT/RO/101.
Reduction of the International Filing Fee Where the
International Application Is Filed in Electronic Form:
Where the international application is filed in electronic form,
the total amount of the international filing fee is reduced
depending on the electronic formats used. The international
filing fee is reduced by: 100 Swiss francs (or the equivalent in
the currency in which the international filing fee is paid to the
receiving Office) in respect of international applications where
the request is not in character coded format (see PCT Schedule
of Fees, item 4(b)); 200 Swiss francs (or the equivalent in the
currency in which the international filing fee is paid to the
receiving Office) where the request is in character coded
format (see PCT Schedule of Fees, item 4(c)); and 300 Swiss
francs (or the equivalent in the currency in which the
international filing fee is paid to the receiving Office) where
the request, description, claims and abstract are all in character
coded format (see PCT Schedule of Fees, item 4(d)). For
further details, see the PCT Applicant’s Guide, International
Phase and Annex C, as well as information published in the
Official Notices (PCT Gazette) and the PCT Newsletter. Since
international applications filed in electronic form will contain
the Request Form and Fee Calculation Sheet in such electronic
form, no provision is made for this fee reduction in the Fee
Calculation Sheet annexed to Form PCT/RO/101.
Reduction of the International Filing Fee for Applicants
from Certain States: An applicant who is a natural person and
who is a national of and resides in a State whose per capita
national income is below 3,000 US dollars (according to the
average per capita national income figures used by the United
Nations for determining its scale of assessments for the
contributions payable for the years 1995, 1996 and 1997), or
who is a national of and resides in one of the following States:
Antigua and Barbuda, Bahrain, Barbados, the Libyan Arab
Jamahiriya, Oman, the Seychelles, Singapore, Trinidad and
Tobago and the United Arab Emirates; or an applicant, whether
a natural person or not, who is a national of and resides in a
State that is classed as a least developed country by the United
Nations, is entitled, in accordance with the Schedule of Fees,
to a reduction of 90% of certain PCT fees including the
international filing fee. If there are several applicants, each
must satisfy the above-mentioned criteria. The reduction of the
international filing fee will be automatically available to any
applicant (or applicants) who is (or are) so entitled on the basis
of the indications of name, nationality and residence given in
Boxes Nos. II and III of the request.
The fee reduction is available even if one or more of the
applicants are not from PCT Contracting States, provided that
each of them is a national and resident of a State that meets the
above-mentioned requirements and that at least one of the
applicants is a national or resident of a PCT Contracting State
and thus is entitled to file an international application.

Notes to the fee calculation sheet (Annex to Form PCT/RO/101) (page 1) (16 September 2012)

page 2

Information about PCT Contracting States whose nationals
and residents are entitled to a reduction of 90% of certain PCT
fees, including the international filing fee, is contained in the
PCT Applicant’s Guide, Annex C and on the WIPO website
(see www.wipo.int/pct/en/), and is also published and regularly
updated in the Official Notices (PCT Gazette) and the PCT
Newsletter.
Calculation of the International Filing Fee in Case of
Fee Reduction: Where the applicant is (or all applicants are)
entitled to a reduction of the international filing fee, the total to
be entered in box I is 10% of the international filing fee (see
below).
Box P: Fee for Priority Document (Rule 17.1(b)): Where
the applicant has requested, by marking the applicable checkbox in Box No. VI of the request, that the receiving Office
prepare and transmit to the International Bureau a certified
copy of the earlier application the priority of which is claimed,
the amount of the fee prescribed by the receiving Office for
such service may be entered (for information, see the PCT
Applicant’s Guide, Annex C).
If that fee is not paid at the latest before the expiration of
16 months from the priority date, the receiving Office may
consider the request under Rule 17.1(b) as not having been
made.
Box RP: Fee for the restoration of the right of priority
(Rule 26bis.3(d)): Where the applicant has requested within
the applicable time limit under Rule 26bis.3(e) that the receiving
Office restore the right of priority in connection with any earlier
application the priority of which is claimed in the international
application, the amount of the fee prescribed by the receiving
Office for such service may be entered (for information, see the
PCT Applicant’s Guide, Annex C).

Box ES: Fee for earlier search documents
(Rule 12bis.1(c)): Where the applicant has requested, by
marking the appropriate check-box in Box No. VII of the
request, that the receiving Office prepare and transmit to the
ISA copies of the documents in connection with an earlier
search, the results of which are requested by the applicant to be
taken into consideration by the ISA (such a request may only be
filed if the earlier search was carried out by the same Office as
that which is acting as the receiving Office (Rule 12bis.1(c))),
the amount of the fee prescribed by the receiving Office for
such service may be entered (for information, see the PCT
Applicant’s Guide, Annex C).
Total Box: The total of the amounts entered in boxes T, S,
I, P, RP and ES should be entered in this box. If the applicant
so wishes, the currency, or currencies, in which the fees are
paid may be indicated next to or in the total box.
MODE OF PAYMENT
In order to help the receiving Office identify the mode of
payment of the prescribed fees, it is recommended that the
applicable check-box(es) be marked. Credit card details should
not be included on the fee calculation sheet. They should be
furnished separately and by secure means acceptable to the
receiving Office.
AUTHORIZATION TO CHARGE
(OR CREDIT) DEPOSIT OR CURRENT ACCOUNT
The receiving Office will not charge (or credit) fees to
deposit or current accounts unless the deposit or current account
authorization is signed and indicates the deposit or current
account number.

Notes to the fee calculation sheet (Annex to Form PCT/RO/101) (page 2) (16 September 2012)