Form DM/1 (Hague System for the International Registration of Industrial Designs)

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DM/1/III (E)

ANNEX III:
INFORMATION ON ELIGIBILITY FOR PROTECTION
under Rule 7(5)(g) and Section 408(d) of the Administrative Instructions

IMPORTANT
1. This cover sheet is optional and serves to submit a statement under Rule 7(5)(g) that identifies information
known by the applicant to be material to the eligibility for protection of the industrial design concerned.
2. This cover sheet is only relevant for the designation of the United States of America and serves to submit
an Information Disclosure Statement and relevant accompanying documentation. Please note that the
Information Disclosure Statement may also be submitted directly to the United States Patent and
Trademark Office (USPTO).
3. The Information Disclosure Statement forms (SB08a/SB08b/SB08a-EFS-web) are available on the USPTO
web site: www.uspto.gov/forms/aia_forms.jsp.
4. For detailed information on the Information Disclosure Statement, please visit the USPTO web site:
www.uspto.gov/web/offices/pac/mpep/s609.html.
5. This cover sheet must be submitted with the DM/1 form at the time of filing. It cannot be submitted alone.
6. Please number your pages.

For use by the applicant

For use by the International Bureau

This Annex concerns the international application
referenced by the applicant as below:

Document type: DDP
Contracting Party: US

Reference:

III

INFORMATION ON ELIGIBILITY FOR PROTECTION

Number of pages:

(including this cover page)

World Intellectual Property Organization
34, chemin des Colombettes, P.O. Box 18,
1211 Geneva 20, Switzerland
Tel.: +41 (0)22 338 9111
Internet: www.wipo.int
Contact Hague

DM/1/III (E) – January 2019