IP/N/IINGA/DIl Page 26 FORM FSI PATENT OFFICE FEE SHEET NOTEs.-One of these sheets to be completed for all payments of fees in respect of Patents, Designs Forms. Please submit the forms in the order dated. Name of Applicant or Agent Address Branch P. r.u. or D. ' Date . . Form No. Application or Patent Number (or surname of first named applicant) AmoLlnt oj Fpe N 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. For Official Use Total amount carried overleaf N k