PATENTS FORM No. l(b) Patents and Designs Act Cap. 344 FEE: ~4 for each convention priority claimed. CONVENTION APPLICATION FOR A PATENT (To be accompanied by two copies of complete Patents Specification Form 3 and requisite fee) NOIE:-This is a comprehensive form, and parts inappropria.tc to a particular application should be cancelled. 1. lAVe (a) ......................................................................... . hereby declare that an application or applications for protection for an invention or inventions has or nave been made in the following country or countries and on the following official date or dates, namely:in(b) ..................................... on (c) .................................... .. by (d) .................................................................................... . Particulars of allY fllrther applications should be givell 011 the back of this form OJ' all a separate sheet. and that the said application or each of the said applications was the first application in a Convention country in respect of the relevant invention by me/us or by any person from whom I/We derive title. 2. I am/We are (e) the assignee(s)-of the said (d) ...................... .. by virtue of (f) ......................................................................... . or (e) the personal representative-of the said (d) .......................... .. 3. I1We declare that to the best of my/our knowledge and belief there is no lawful ground of objection to the grant of a patent to me/us on this application, and pursuant to subsection 2 of section 27 of the Act, lAVe pray that a patent may be granted to me/us with priority founded on the above-mentioned application(s) in a Convention country or countries as provided by subsection (4) of section 3 for the invention described in the accompanying complete specification under the title ........................ . 4. And I/We request that the patent may be granted as a patent of addition to (e) {patent No ........................ .. the patent to be granted on application No. 5. And IIWe request that all notices, requISItIOnS, and communications relating to this application may be sent to ......................... .. who are hereby appointed to act for me/us. 6. And I/\Ve do hereby declare that the true inventor(s) of the invention disclosed in the complete specification filed with the present application is/are (i) ................................................................. .