SINGAPORE PATENTS ACT (CHAPTER 221)
PATENTS RULESPATENTS FORM 12

Request for Examination Report

Pre-requisites:
a. If you are relying on an International Search Report or a Search Report of a corresponding application, corresponding
international application or related national phase application, this form is to be accompanied by:− A copy of the search report and if this report is not in English, a verified English translation of the report.
− Each cited document referred to in the search report.
− If one or more cited document referred to the search report is not in English, a list of references to the patent family
members of these cited documents and where this list is not in English, a verified English translation of this list.
b. If you are making a request under the ASEAN Patent Examination Co-operation (ASPEC) programme or a request under
the Patent Prosecution Highway (PPH), please refer to the ASPEC or PPH Notice and Procedures available on IPOS's
website at http://www.ipos.gov.sg for the documents to be filed together with this form.
Estimated Time:
This form may take approximately 8 - 12 minutes to complete.
General:a. * denotes mandatory fields.
b. Attention is drawn to sections 104 and 105 of the Patents Act, rules 90 and 105 of the Patents Rules, and the Patents(Patent Agents) Rules 2001.

PART 1

Reference
Applicant/ AgentReference

PART 2

Application No.*
Application No.*PART 3Name of Applicant*Note: If there is insufficient space, please use the continuation sheet CS 4.

UEN/ Company Code(if applicable)

Name

Sole Proprietor orPartners' Name
(if sole proprietorship orpartnership)

PART 4

Request Type*
Request Type*(Note:Cross only onecheckbox)

Request for an examination report relying on a search reportissued by the Registrar
Request for an examination report relying on an international
search report

V1.20170401

Page 1 of 4

Request for an examination report relying on the search reportof a corresponding application, corresponding international
application or related national phase application
Application/ PatentNo.
Prescribed PatentOffice/ PCT
PART 5Additional Information Required for Patents Form 12 filed on or after 01 Apr 2017

Number of Claims

PART 6Grace Period

There has been a disclosure of matter of the invention
12 months prior to the date of filing this application

ASEAN Patent Examination Co-operation (ASPEC) / Patent Prosecution Highway (PPH)ASPEC / PPH(Note: Please cross ifapplicable)

PART 8claim(s)Grace Period(Note: Please cross ifapplicable)

PART 7sheet(s)ASPEC / PPH requested and required documents are attached

Contact Details*

Note:a. Where an agent with UEN is appointed, the fields for "Agent UEN/ Company Code", "Agent Name" and "Address forService in Singapore" should be completed. Where an individual or an agent without UEN is appointed, the sub-field“Representative or C/O Name” and "Address for Service in Singapore" should be completed instead.
b. The official correspondence will be sent to the address for service in Singapore as indicated in this box, and must be thesame as the one on our record.
c. Please file Form CM1 if you are a different agent or Form CM2 if you have changed your address for service in Singapore.

Agent UEN/ Company
Code
Agent Name

Representative or C/OName
Address for Service in Singapore
Block/ HouseNo.
Street Name
Level - Unit-

BuildingName
Postal CodeV1.20170401

Page 2 of 4Contact Person(if applicable)

Direct Telephone No.
(if applicable)

Email Address(if applicable)

PART 9Declaration*
Declaration

By Person Filing the FormI, the undersigned, do hereby declare that the information furnishedabove is true to the best of my knowledge. I understand that I may beliable for criminal prosecution for providing any false information in thisapplication.
By Agent
I, the undersigned, do hereby declare that:i.

I have been duly authorised to act as an agent on behalf of theperson(s) filing this form.

ii.

The information furnished above on behalf of the person(s) filingthis form is true to the best of the person(s)' knowledge. I
understand that I may be liable for criminal prosecution forproviding any false information in this application.

Name

SignatureDate(DD/MM/YYYY)

No. of Extra Sheets
Attached to this Form

V1.20170401

sheet(s)Page 3 of 4

GST

GST INFORMATIONTax Invoice*Note:
Tax invoice will be issued to the entity/individual as indicated. Goods and Services Tax (GST)-registered businesses may claim
input tax with Inland Revenue Authority of Singapore (IRAS), subject to meeting the requirements under the GST Act.

The name of the Applicant (as in PART 3 of this form) is to be indicated in this field.

Name (Tax invoice to beissued to)V1.20170401

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