Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694491498496.pdf (Antigua and Barbuda)
SCHEDULE II INTELLECTUAL PROPERTY OFFICE, ANTIGUA AND BARBUDA Form No.1 Patents ACT REQUEST OF GRANT OF PATENT OR UTILITY CERTIFICATE To: The Registrar Intellectual Property Office THE APPLICANTS REQUEST CERTIFICATE IN RESPECT OF THE FOLLOWING PARTICULARS: For Official use Date of Receipt by Intellectual Property Office: APPLICATION No: (Office’s Stamp) FILING DATE Applicants or Representative File Reference: THE GRANT OF A PATENT THE GRANT OF A UTILITY I.

TITLE OF INVENTION:………………………………………………………….. II.


APPLICANT(S) Additional information is contained in supplemental box.
Name …………………………………………………………………..……………… Address (es) …………………………………………………………………………… Nationality/Nationalities ……………………………………………………………… Country/countries of residence or principal place of business: ………………………………………………………………………………………… Tel No:……………………Fax No:………………………….Email:…………………….. *The data concerning each applicant must appear in this box or, if the space is insufficient, in the supplemental box.

Address for service in Antigua and Barbuda* III.
Agent The following agent has been appointed by the applicant in the authorization of agent Accompanying this form to be filed within two months from the filing of this Form Name ……………………………………………………………………………………………… Address …………………………………………………………………………………………… Tel No:………………………..Fax No:…………………………E-mail:……..………………….. IV INVENTOR The inventor is the applicant If inventor is not the applicant Additional information is contained in supplemental box Name ……………………………………………………………………………………………….
Address: …………………………………………………………………………………………… The statement justifying the applicant’s right accompanies this Form V DIVISIONAL APPLICATION This application is a divisional application Filing date ………………………….. priority date of the initial application is claimed in as much as the subject matter of the present application is contained in the initial application identified below Initial Application No.

:………………………………………………………..


Date of filing of initial application :…………………………………………… Where an attorney at law or a patent agent has been appointed, his address shall be treated as the address to which communications shall be transmitted.

VI DISCLOSURES TO BE DISRTGARDED FOR PRIOR ART PURPOSES Disclosure occurred not more than one year before the filing date or priority date of the present application by reason or in consequence of acts of the applicant or his predecessor¡ in title.
Of an abuse committed by a third party with regard to the rights of the applicant or his predecessor in title.
Additional information in a statement accompanying this Form VII PRIORITY DECLARATION (if any) The priority of (an) earlier application(s) is claimed as follows The priority of more than one earlier application is claimed; the data are indicted in the supplemental box Country (if the earlier application is a regional or international application, indicate the office with which and the countries for which it was filed): ……………….…………………………….

Filing Date………………………….


Application No…………………….. Symbol of the International Patent Classification: ……………………………………… not yet allocated The certified copy of the earlier application accompanies this Form.
will be furnished upon request by the Registrar as prescribed by section 20(2) has already been furnished with application No The English translation of the earlier application accompanies this Form Will be furnished upon request, as prescribed by section 20(3) VIII SUPPLEMENTAL BOX* Use this box if any of the boxes is not large enough to contain information to be furnished.

Indicate the boxes continued in this by their roman numerals and title [e.g.
APPLICANT(s) (continued)”] IX CHECK LIST (TO BE FILLED IN BY THE APPLICANT) A.
This application contains following B) This Form, as filed, is accompanied below by the items ticked 1. request…………………sheet(s) separate signed authorization of agent 2. description……………..sheet(s) statement justifying the applicants right 3. claim(s) ……………….sheet(s) statement that certain disclosures be disregarded 4. abstract…….…………..sheet(s) priority document(s) [certified copy of earlier application(s)] 5. drawing(s) …….………sheet(s) English translation of earlier application(s) on which priority declaration is based.
Total sheet(s) C. Figure number ……… … Of the drawings (if any) is suggested to accompany the abstract for publication Application fee Other document(s) (specify) See supplemental Box X.

SIGNATURE(S) …………………………..

Date ………………….. ………………………………………………………… ….………………………………… {Name} agent or applicant Type name(s) under signature(s).

Indicate whether agent or applicant TO BE FILLED IN BY THE REGISTRAR 1.
Date of receipt or corrections or later filed documents completing the application: …………………………………………………………………………………………………… 2.

Date fees received: ………………………………………………….................................. (Form No.

1, fifth and last page).