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

PCT

For receiving Office use only
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) (25 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. E-mail address*

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.)

Telephone No.
Facsimile No.
Applicant’s registration No. with the Office
* E-mail authorization: Indicating an e-mail address above authorizes the receiving Office, the International Searching Authority and the
International Bureau, if they provide such a service, to send notifications exclusively by e-mail to that address, unless the following box is
marked:
notifications are requested to be sent exclusively by postal mail.
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
agent
of the applicant(s) before the competent International Authorities as:
Name and address: (Family name followed by given name; for a legal entity, full official designation. E-mail address*

common
representative

The address must include postal code and name of country.)

Telephone No.
Facsimile No.
Agent’s registration No. with the Office
* E-mail authorization: Indicating an e-mail address above authorizes the receiving Office, the International Searching Authority and the
International Bureau, if they provide such a service, to send notifications exclusively by e-mail to that address, unless the following box is
marked:
notifications are requested to be sent exclusively by postal mail.
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) (July 2022)

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) (July 2022)

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) (July 2022)

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), or an element or part of the description, claims or drawings referred
to in Rule 20.5bis(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) (July 2022)

See Notes to the request form

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

USE OF EARLIER SEARCH AND CLASSIFICATION RESULTS

1. Request by the applicant under Rule 4.12
1.1

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 Continuation of Box No. VII, item 1; use of results of more than one earlier search)
Filing date (day/month/year)
Application Number
Country (or regional Office)

1.2

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.
Submission of the earlier search results, where necessary*
Availability of documents (Rules 12bis.1(c) and (d) and 12bis.2(b)): the following documents are available to the ISA in a
form and a manner acceptable to it, and therefore DO NOT need to be submitted by the applicant to the receiving Office, or to
the ISA.
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 earlier search results (if known, please indicate below the documents available to the ISA):

Request from the applicant to the receiving Office to transmit to the ISA a copy of the earlier search results (Rule 12bis.1(b)
and (d)): (where the earlier search was not carried out by the ISA indicated in Box No. VII but by the same Office as that which
is acting as receiving Office; or where the earlier search results are otherwise available to the receiving Office): the applicant
requests the receiving Office to prepare and transmit to the ISA a copy of the earlier search results.
* The applicant only needs to furnish a copy of the earlier search results to the receiving Office, or the ISA, if none of the scenarios
mentioned under item 1 applies. (See item 10 in the check-list and also Notes to Continuation of Box No. VII, item 1).
Further earlier searches are indicated on a continuation sheet.
2. Transmission of the earlier search and classification results to the ISA by the receiving Office where the applicant DID NOT
make a request under Rule 4.12
2.1 Where the international application claims priority of an earlier application, subject to Article 30(2)(a) and (3), the receiving Office:
– shall transmit a copy of the earlier search and classification results to the ISA (unless such copy is already available to the ISA),
where the earlier application was filed with the same Office as that which is acting as the receiving Office and that Office has
carried out the earlier search in respect of the earlier application (Rule 23bis.2(a));
– may transmit such a copy if the earlier application was filed with a different Office, but where the results of that earlier search
and classification are nevertheless available to the receiving Office (Rule 23bis.2(c)).
However, where the applicant did not request the receiving Office to transmit to the ISA a copy of the earlier search results under
Rule 4.12 (see above item 1), in respect of an earlier search carried out on the following earlier application, the priority of which is
subsequently claimed in this international application, the applicant may consider (see also Notes to Continuation of Box No. VII,
item 2; use of more than one earlier search):
Filing date (day/month/year)
Application Number
Country (or regional Office)
2.2 Request not to transmit the earlier search results by the receiving Office to the ISA (Rule 23bis.2(b))
to request that the receiving Office DOES NOT transmit the results of the earlier search to the ISA (Rule 23bis.2(b)) (may only
be checked where the international application is filed with the following receiving Offices: DE, FI and SE)
2.3 Authorization to transmit the earlier search and classification results by the receiving Office to the ISA (Rule 23bis.2(a) and (e))
to authorize the receiving Office to transmit the results of the earlier search and classification to the ISA (Rule 23bis.2(e)) (may
only be checked where the international application is filed with the following receiving Offices: AU, CZ, FI, HU, IL, JP, NO, SE,
SG and US)
to authorize the receiving Office to transmit the results of the earlier international search and classification to the ISA (Rule 23bis.2(a)
and Article 30(2)(a) and (3)) (may only be checked where the earlier search concerns an international application, the priority
of which is subsequently claimed in this international application and where the earlier international search was carried out by a
different ISA than the ISA chosen in 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):
Box No. VIII (i)
Declaration as to the identity of the inventor

Number of
declarations
:

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

:

Box No. VIII (iv)

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

:

Box No. VIII (v)

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

:

Form PCT/RO/101 (third sheet) (July 2022)

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)) (July 2022)

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)) (July 2022)

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)) (July 2022)

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)) (July 2022)

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)) (July 2022)

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 three
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) (July 2022)

See Notes to the request form

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

CHECK LIST for PAPER filing – only to be used when filing 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) . . . . . . . . . . . . . . . . . . . . . . :

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 . . . . . . . . . .

:

8.

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

:

9.

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

:

(b) description . . . . . . . . . . . . . . . . . . :
(c) claims . . . . . . . . . . . . . . . . . . . . . . :
5.

(d) abstract . . . . . . . . . . . . . . . . . . . . . :
(e) drawings (if any) . . . . . . . . . . . . . . :

6.

7.
Total number of sheets

0

:

(f) sequence listing part of the description as a
WIPO Standard ST.26 XML 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:
received:

3. Corrected date of actual receipt due to later but
timely received papers or drawings completing
the purported international application:
4. Date of timely receipt of the required
corrections under PCT Article 11(2):
5. International Searching Authority
(if two or more are competent):

not received:
6.

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) (July 2022)

See Notes to the request form

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

CHECK LIST for electronic filing with RO/US – only to be used when filing via the USPTO electronic filing system

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) . . . . . . . . :

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 . . . . . . . . . .

:

8.

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

:

9.

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

:

(b) description . . . . . . . . . . . . . . . . . . . :
(c) claims . . . . . . . . . . . . . . . . . . . . . . . :
(d) abstract . . . . . . . . . . . . . . . . . . . . . . :
5.

(e) drawings (if any) . . . . . . . . . . . . . . . :

Total number of sheets . . . . . . . . . . . . :

0

(f) sequence listing part of the description

6.

7.

filed as a WIPO Standard ST.26 XML file
WILL BE filed separately on physical data
carrier(s) as a WIPO Standard ST.26 XML
file, on the same day
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:
received:

3. Corrected date of actual receipt due to later but
timely received papers or drawings completing
the purported international application:
4. Date of timely receipt of the required
corrections under PCT Article 11(2):
5. International Searching Authority
(if two or more are competent):

not received:
6.

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 – electronic filing with RO/US) (July 2022)

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)).
CONFIRMATION COPY
OF THE REQUEST FORM
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.
APPLICANT’S OR AGENT’S FILE REFERENCE
A File Reference may be indicated, if desired. It should
not exceed 25 characters. Characters in excess of 25 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.
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 “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 check-box 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.
A person must not be named more than once in Boxes Nos. II
and III, even where that person is both applicant and inventor.
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.
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.
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.

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.

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.

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.

Only one address may be indicated per person. For the
indication of a special “address for correspondence”, see the
notes to Box No. IV.

Notes to the request form (PCT/RO/101) (page 1) (July 2022)

page 2

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. In order to allow rapid and safe receipt
of notifications from Offices, it is strongly recommended that
an e-mail address is provided to receive notifications.
If an e-mail address is indicated, the receiving Office and
the International Searching Authority, if they provide such a
service, and the International Bureau will send notifications to
that address by e-mail. In this case, no paper notifications will
be sent by postal mail, unless the relevant Office is willing to
additionally send such paper notifications. 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 no e-mail address is provided, or if the applicant chooses
to receive notifications exclusively by postal mail, or in the
cases where the receiving Office or the International Searching
Authority does not provide for sending notifications by e-mail,
notifications will be sent to the given address exclusively by
postal mail.
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, e-mail communications will be sent 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 two-letter 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
Notes to the request form (PCT/RO/101) (page 2) (July 2022)

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).
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.

page 3

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), 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

Notes to the request form (PCT/RO/101) (page 3) (July 2022)

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) or (a-bis), of the incompatibility of
the provisions on incorporation by reference with its national law.
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
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 missing part in accordance with Rule 20.6(a) 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(d)).

page 4

Where, in the case of an element or part having been
erroneously filed, the applicant furnishes the correct element
or 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, the correct element or part
will be included in the international application, the erroneously
filed element or part will be removed from the international
application, and the international filing date will be corrected
to the date on which the receiving Office received that element
or part (see Rule 20.5bis(c)). In such a case, the applicant will
be given the opportunity to request the receiving Office to
disregard the correct element or part concerned, in which case
the correct element or part would be considered not to have
been furnished and the correction of the international filing
date not to have been made (see Rule 20.5bis(e)). However,
where the applicant confirms the incorporation by reference of
the correct element or part in accordance with Rule 20.6(a) and
the receiving Office finds that all the requirements of Rules 4.18
and 20.6(a) are complied with, the correct element or 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.
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 check-boxes
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/das/en), 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 (unless the applicant has already
automatically received the access code from the depositing
Office in the priority application filing process). The applicant
should then mark the applicable check-boxes in Box No. VI, and
indicate the access code for each specific priority document.
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

Notes to the request form (PCT/RO/101) (page 4) (July 2022)

or hyphens, for example, “26 October 2018 (26.10.2018)”,
“26 October 2018 (26/10/2018)” or “26 October 2018
(26-10-2018)”.
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.
Continuation of BOX No. VII, item 1
Request to Use Results of Earlier Search; Submission of
Earlier Search Results (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 or
regional Office (Rule 4.12). Where the applicant has made such
a request and complied with the requirements under Rule 12bis,
and where the earlier search was carried out by the same ISA or
by the same national or regional Office as that which is acting as
the ISA, 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 a national or regional
Office other than that is acting as the ISA, 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 or where the earlier
search results are otherwise available to the receiving Office, the
applicant may, instead of submitting a copy of the results of the
earlier search, request the receiving Office to transmit a copy of
those results to the ISA by marking the appropriate check-box
(Rule 12bis.1(b) and (d));
– where the earlier search was carried out by the same Authority
or Office as that which is acting as ISA, no copy of the results
of the earlier search is required to be submitted to the receiving
Office or to the ISA (Rules 12bis.1(c) and 12bis.2(b));
– where a copy of the results of the earlier search is available
to the receiving Office or 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 of the
results is required to be submitted to the receiving Office or to
the ISA (Rules 12bis.1(d) and 12bis.2(b));
Where the applicant has made a request under Rule 4.12, the
earlier search results to be submitted by the receiving Office to
the ISA shall include, where applicable, a copy of any earlier
classification results (Rule 23bis.1(b)).
Use of Results of more than one Earlier Search: Where the
ISA is requested to use the results of more than one earlier search,
please mark the relevant check-box, and furnish duplicates of
this page, marked “continuation sheet of item 1 of Continuation
of Box No. VII”, attached to the request form.

page 5

Continuation of BOX NO. VII, item 2
Transmission of the Earlier Search and Classification
Results to the ISA by the Receiving Office where the applicant
did not make a request under Rule 4.12 Where the international
application claims priority of an earlier application, subject to
Article 30(2) and (3), the receiving Office shall transmit to the
ISA a copy of the results of the earlier search and classification
(unless such copy is already available to the ISA) if the earlier
application was filed with the same national or regional Office as
that which is acting as the receiving Office, and that Office has
carried out the earlier search in respect of the earlier application
(Rule 23bis.2(a)); the receiving Office may transmit a copy of
the results of the earlier search and classification if the earlier
application was filed with a different Office but where the results
of that earlier search and classification are nevertheless available
to the receiving Office (Rule 23bis.2(c)).
Request not to Transmit the Earlier Search Results by
the receiving Office to the ISA: Where the international
application is filed with a receiving Office which has
notified the International Bureau under Rule 23bis.2(b) that
it may, on request of the applicant, decide not to transmit
the results of an earlier search to the ISA, the applicant
may check the check-box in item 2.2 of Continuation of
Box No. VII. This only concerns international applications
filed with the following receiving Offices: DE, FI and SE
(see www.wipo.int/pct/en/texts/reservations/res_incomp.html).
Authorization to Transmit the Earlier Search and
Classification Results by the receiving Office to the ISA: Where
the international application is filed with a receiving Office which
has notified the International Bureau under Rule 23bis.2(e) that the
transmission of copies of earlier search and classification results
without the authorization of the applicant is not compatible with
the national law applied by the receiving Office, the applicant
may check the first check-box in item 2.3 of Continuation of Box
No. VII to nevertheless authorize the receiving Office to transmit
the earlier search and classification results to the ISA. This only
concerns international applications filed with the following
receiving Offices: AU, CZ, FI, HU, IL, JP, NO, SE, SG and US.
(see www.wipo.int/pct/en/texts/reservations/res_incomp.html).
In respect of all receiving Offices, the second check-box in
item 2.3 of Continuation of Box No. VII may also be used to
expressly authorize the receiving Office to transmit the earlier
search and classification results where the earlier search was
carried out in respect of an international application, the priority
of which is subsequently claimed in this international application
and where the earlier international search was carried out by a
different ISA than the ISA chosen in Box No. VII.
Use of Results of more than one Earlier Search: Where
the international application claims priority of more than one
earlier application, and where the applicant is entitled and wishes
to make an indication under item 2.2 or 2.3 (Rule 23bis.2(a)(b)
and (e)) for each earlier application, please mark the relevant
check-box, and furnish duplicates of this page that lists each
priority claim concerned, marked “continuation sheet of item 2
of Continuation of Box No. VII”, attached to the request form.
BOX No. VIII
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);

Notes to the request form (PCT/RO/101) (page 5) (July 2022)

(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 check-boxes 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.
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.
BOXES Nos. VIII (i) TO (v)
(IN GENERAL)
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.
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;

page 6

if they do not apply, they should be omitted together with
the corresponding brackets.

(viii) the applicant’s name changed from … (name) to …
(name) on … (date)”

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.

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:

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/…],
... (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 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 …
Notes to the request form (PCT/RO/101) (page 6) (July 2022)

“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 preceding 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

page 7

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)).

sequences, the sequences must be presented in a sequence listing
in compliance with WIPO Standard ST.26 (XML file). It is
strongly recommended to file the entire application electronically
whenever possible. If the sequence listing is too large to upload to
the receiving Office online filing system, applicants may provide
the sequence listing on physical data carrier(s) accepted by the
Office and indicate the type and number of the carriers.
Nevertheless, if an international application containing a
sequence listing is filed on paper, the sequence listing must be
filed on physical data carrier(s) labeled “Sequence Listing”; the
type and number of the carriers such as diskettes, CD-ROMs,
CD-Rs or other data carriers accepted by the ISA, should be
indicated in item (f).
__________________________________________________
Electronic filing with RO/US

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)).

The sheet containing Box No. IX CHECK LIST for electronic
filing with RO/US “(last sheet – electronic filing with RO/US)”
should only be used if the request form is filed online with the
receiving Office of the United States of America (RO/US).

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).

The RO/US has a limitation on the size of the XML sequence
listing file it can accept electronically. If the XML file containing
the sequence listing, or a compressed zip file package thereof, is
larger than 100MB, the applicant must file the sequence listing
on physical data carrier(s) labeled “Sequence Listing”. 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 “Priority Mail Express Post Office to Addressee” service with
a “date accepted” by the United States Postal Service the same
date as the online filing date. Alternatively, the data carrier(s)
may be submitted using commercial delivery services or by hand
delivery to the Customer Service Window, provided that it reaches
the RO/US on the same day as the international application filed
online. In such cases, the corresponding check-boxes in checkbox (f) in Box No. IX must be marked. The number and type of
carrier(s) should be indicated in check-box (f).
__________________________________________________

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. Any
tables, including those related to a disclosure of sequences, form
an integral part of the description and the pages containing such
tables will be counted as sheets of the description.
Nucleotide and/or amino acid sequences: If the international
application contains disclosure of nucleotide and/or amino acid

Notes to the request form (PCT/RO/101) (page 7) (July 2022)

Nucleotide and/or amino acid sequences: Where the
international application containing a sequence listing is filed
electronically, the first check-box of check-box (f) in Box No. IX
should be marked. An international application that includes a
WIPO Standard ST.26 XML file can only be filed electronically
with RO/US via the USPTO Patent Center web interface.

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.
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 filledin 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).

page 8

Language of Filing of the International Application
(Rules 12.1(a) and 20.1(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 check-box (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)); as regards
the language of the language-dependent free text contained in
the sequence listing part of the description, see Rule 12.1(d)).
Note that where the international application is filed with the
RO/US, all elements of the international application (request,
description, sequence listing part of the description, claims,
abstract and text matter of drawings) must, for the purposes
of according an international filing date, be only in English,
including the language-dependent free text in any sequence
listing part of the description.
BOX No. X
Signature (Rules 4.1(d), 4.15, 26.2bis(a), 51bis.1(a)(vi)
and 90): 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.
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), or by an agent or
a common representative whose appointment has been
effected by each applicant signing, at his choice, the request,
the demand, a separate power of attorney (Rule 90.4(a)) or
a general power of attorney (Rule 90.5(a)).
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 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.
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.
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.
GENERAL REMARKS
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.
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.
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, the claim(s),
the abstract, the drawings (if any).
All sheets of the description, 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).
Indication of the Applicant’s or Agent’s File Reference
on the sheets of the description, claim(s), abstract and drawings
(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) (July 2022; updated June 2022)

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
(Applicants may be entitled to a reduction of certain fees as indicated in the PCT Fee Tables
(www.wipo.int/pct/en/fees.pdf))
1. TRANSMITTAL FEE: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

T

2. SEARCH FEE: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S

International search to be carried out by: _______
3. INTERNATIONAL FILING FEE
Enter total number of sheets indicated in Box No IX: _______
i1

i1 Fixed amount for the 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 (see
www.wipo.int/pct/en/fees/fee_reduction.pdf). 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)
credit card (details should
not be included on this
sheet)

authorization to charge deposit
or current account (see below)

bank transfer

cash

postal money order

check

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) (July 2022)

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 and the International Bureau at
www.wipo.int/pct/en/fees.pdf. 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 Total number of sheets
of the international application indicated in Box No. IX of the
request. No fee is charged for any WIPO Standard ST.26 XML
sequence listing.
The international filing fee must be paid within one month
from the date of receipt of the international application by the
receiving Office.
Reductions: Applicants may be entitled to reductions
to certain fees, which are indicated in the PCT Fee Tables
(www.wipo.int/pct/en/fees.pdf) and the relevant Annex C of
the PCT Applicants Guide. If reduced fees apply, the reduced
amount should be indicated in the fee calculation sheet.
These include reductions that apply where the international
application is filed in electronic form and/or if the applicant is
a natural person from certain States. These two types of fees
reduction are fully explained below.
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(a));
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(b)); 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(c)). 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 that is listed as
being a State whose per capita gross domestic product is below
US$ 25,000 (according to the most recent ten year average per
capita gross domestic product figures at constant 2005 US$
values published by the United Nations), and whose nationals
and residents who are natural persons have filed less than 10
international applications per year (per million population) or less
than 50 international applications per year (in absolute numbers)
according to the most recent 5-year average yearly filing figures
published by the International Bureau; or an applicant, whether
a natural person or not, who is a national of and resides in a
State that is listed as being classified by the United Nations as
a least developed country, is entitled, in accordance with the
Schedule of Fees, to a reduction of 90% of certain PCT fees
including the international filing fee. The applicant is only
entitled to the reduction of the international filing fee if, at the
time of filing of the international application, the applicant is or
all applicants are the true and only owner(s) of the application
and under no obligation to assign, grant, convey or license the
rights in the invention to another party which is not eligible for
the fee reduction. If there are several applicants, each must
satisfy the above-mentioned criteria. If the applicant is or all
applicants are entitled to the reduction of the international filing
fee, this reduction applies on the basis of the indications of name,
nationality and residence given in Boxes Nos. II and III of the
request, without the need for a specific request to be made.
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.
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).

Notes to the fee calculation sheet (Annex to Form PCT/RO/101) (page 1) (July 2022)

page 2

Box P: Fee for Priority Document (Rule 17.1(b)): Where
the applicant has requested, by marking the applicable check-box
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(b)
and (d)): Where the applicant has requested, by marking
the appropriate check-box in item 1.2 of Continuation of
Box No. VII, of the request, that the receiving Office prepare
and transmit to the ISA copies of the results of an earlier
search, 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(b)) or where the
earlier search results are otherwise available to the receiving
Office (Rule 12bis.1(d)), 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) (July 2022)