321 Form No. I (cont'd) will be furnished upon request, by the Registrar, as prescribed by Regulation 19(5). D The certified English translation of the earlier application accompanies this Form D D VIII. will be furnished upon request, as prescribed by Regulation 19(7). SUPPLEMENTAL BOX* IX. CHECK LIST A. This appiication contains the following: request................. sheet(s) description............ sheet(s) 3. claim(s)................ sheet(s) 4. abstract................ sheet(s) 5. drawing(s) .............. sheet(s) 1. 2. Total sheets C. Figure number ... of the drawings (if any) is suggested to accompany the abstract for publication B. This Form, as filed, is accompanied by the items ticked below: separate signed power of attorney statement justifying the applicant's right statement that certain disclosures· b~ disregarded priority document(s) (certified copy of earlier application(s» certified English translation of earlier application(s) on which priority declaration is based application fee D D D D D D D other document(s) (specify) X. SIGNA TURE(S) ** (Applicant(s)/ Agent) (Date)