Patents Form 12
Patents Act 1977 (Rule 36)

Payment of renewal fee (and additional fee for late payment)(See the notes on the back of this form)

Concept House&DUGLႇ5RDG
NewportSouth Wales
NP10 8QQ

1 Your Reference
2 Patent Number
3 Which year are you paying for?
(In terms of the life of the patent e.g. 6th)
4 Amount of renewal fee
Amount of late payment fee
Total amount paid 1DPHDGGUHVVDQGSRႋFRGHRIWKHSHUVRQpaying the fee

Patents ADP number (if you know it) ,I\RXUQH[WUHQHZDOLVRYHUGXHWKH2ႈFHZLOOVHQGDreminder to your chosen address. If you havepreviously provided an Address for Service or a
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remains unchanged, you can leave this space blank.
However, if you wish to change your chosen address,
please provide the details here and sign and date it.
(see note c for further details)

Signature

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Date7 Name, email address, telephone and/or
mobile number, if any, of a contact point for theapplicant

Intellectual Property Ofﬁce is an operating name of the Patent Ofﬁce

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Data Privacy: https://www.gov.uk/government/organisations/intellectual-property-ofﬁce/about/personal-information-charter

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PF12

Fees and payment
We will only process the form with this section completed (one form per payment)
To check the correct fee for this form, search on GOV.UK for ‘patent forms and fees’
Total Fee Paying (£)

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Your contact details should we have a query
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Tick one
Using a debit or credit card – you will need the internet to pay by card1

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2

Enter your name, email address and total amount to pay from above

3

As proof of payment, write below the 16-digit reference number displayed from theonline payment screen.
DO NOT write your debit/credit card number

Deduct from IPO deposit accountIPO deposit account number

Cheque – make payable to ‘Intellectual Property Ofﬁce’and please send to the address speciﬁed below.
Bank transfer
Reference – use your IPO deposit account number if you have one or anapplication number or your name if you don’t.
Use the following bank account details
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IBAN number

20-18-2380531766
Intellectual Property Ofﬁce
BARCGB22
GB92 BARC 2018 2380 5317 66

Post to: Intellectual Property Ofﬁce, Concept House, Cardiff Road, Newport, South Wales, NP10 8QQ, United Kingdom
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