NATIONAL PHASE ENTRY
APPLICATION FORM
[ ]INVENTIONAPPLICATION NO.

(IPO USE ONLY)DATE OF NATIONAL PHASE ENTRY (IPO USE ONLY)DATE OF RECEIPT(IPO USE ONLY)DATE OF MAILING(IPO USE ONLY)

The undersigned hereby requests for substantive examinationand grant of a Philippine patent for the subject application.

[ ]UTILITY MODEL

The undersigned hereby requests that this utility model
application be registered.

I. INTERNATIONAL APPLICATION NO.

II. INTERNATIONAL FILING DATEIII. LANGUAGE OF INTERNATIONALAPPLICATION

IV. INTERNATIONAL PUBLICATION NO.

V. INTERNATIONAL PUBLICATION
DATE

VI. LANGUAGE OF INTERNATIONAL
PUBLICATION

VII. TITLE OF INVENTION/UTILITY MODEL

VIII. A. EARLIEST PRIORITY DATE CLAIMED (indicate Application No., Filing Date and Country of Filing):

B. If the priority is based on an earlier Philippine national application, applicant(s) hereby elect(s) the following
application for prosecution: [ ] International Application [ ] Philippine National Application
IX. APPLICANT(S) (indicate Name and Address)[] Big Entity (Total Assets of more than 100M)[ ] Small Entity (Total Assets of 100M or less)□ Further applicants are indicated on a continuation sheet.
X. INVENTOR(S)/MAKER(S) (Mark the appropriate box.)□ The inventor(s)/maker(s) are the same as that contained on the front page of the international publication, which isattached herewith.

□ The inventor(s)/maker(s) are the same as that contained on the front page of the international publication, which isattached herewith, except for changes set out below.

NAME(S) OF INVENTOR(S)/MAKER(S) (indicate Name and Address)[] Same as Applicant(s)XI. CHECKLIST. All documents must be in English or translated

XIII. OTHER DOCUMENT(S)/ITEM(S) INCLUDED.

into English.

documents must be in English or translated into English.

1. [
1.
2.
3.
4.

Description and claims
Abstract
Drawing (s)Sequence Listing (paper)
Sequence Listing(PDF OCR)

Total
XII. CLAIMS
Total No. of Claims:____________ Sheets____________ Sheets____________ Sheets____________ Sheets____________ Sheets____________ Sheets

2. [
3. [
4. [
5. [
6. [
7. [All] Amendments[ ] Under PCT Article 19[ ] Under PCT Article 34] International Search Report] International Preliminary Examination] POA/ARA] PCT/IB/304] Physical data carrier containing Sequence Listing inPDF OCR] Other __________________________________________

XIV. AGENT (IF ANY) OR COMMON REPRESENTATIVE (IF ANY) IN THE PHILIPPINES The following person (includes,where applicable, a legal entity) is hereby/has been appointed as agent or common representative to act on behalf of theapplicant(s) before the Intellectual Property Office (IPO). Sec. 33 of R.A. No. 8293 requires a resident agent for applicants
who are non-residents of the Philippines.
Name and local address, including postal code:

Tel. No. (including area code):
Fax No. (including area code):E-mail Address:

XV. SIGNATURE OF APPLICANT(S) OR AGENT OVER PRINTED NAME(S) If this Request Form is signed by a resident
agent, a separate Power of Attorney/Appointment of Resident Agent duly signed by the applicant(s) shall be submitted to theIPO.
(Revision 01) (March 2015)

GUIDE TO THE NATIONAL PHASE ENTRY APPLICATION FORM
TO BE FILLED UP BY IPOPHL
Application No. - This is the application number issued by the IPOPHL for the specific application submitted (e.g. 1-2013-500001). When
this application number is issued, all communications/actions intended for this application number should contain said number.
Date of National Phase Entry – This is the “Date” given to an International Application that has entered into the National Phase.
Date of Receipt – This is the “actual date” when the International Application has been received and entered into the Office’s receiving
system by the Duty Officer of the day.
Date of Mailing – This is the stamped date of receipt by the Post Office of the international application entering into the national phaselodged for mailing to the Office. The “Date of Mailing” shall be considered as the Date of National Phase Entry in accordance withMemorandum Circular No. 3, Series of 2011.
TO BE FILLED UP BY THE APPLICANT[ ] Invention – Mark this box if the international application is intended as an invention application.
[ ] Utility Model – Mark this box if the international application is intended as a utility model application.
I.

International Application No. – This is the application number assigned to the international application by the receiving Office (e.g.
PCT/US2011/000001).

II.

International Filing Date – This is the filing date of the international application accorded by the receiving Office.

III.

Language of International Application – This is the language in which the international application was written when it was filed withthe receiving Office.

IV.

International Publication No. – This is the publication number given by the International Bureau (IB) of the World Intellectual Property
Organization when the international application was published (e.g. WO2012/123456).

V.

International Publication Date – This is the date when the international application was published by the IB.

VI.

Language of International Publication – This is the language in which the international application was published by the IB.

VII. Title of Invention/Utility Model – This shall be as short and specific as possible. It shall appear as a heading on the first page of thedescription. (Revised Implementing Rules and Regulations for Patents, Utility Model and Industrial Design (IRR) Rule 410)
VIII. A. Earliest Priority Date Claimed – This is the date on which the earlier application was filed from which priority is claimed in theinternational application.
B. If the priority is based on an earlier Philippine national application, applicant(s) hereby elect(s) the following application
for prosecution: - If applicable, the applicant shall choose which application shall be prosecuted should there be both an earlier filed
local Philippine application and an international application that has entered into the national phase claiming priority over that earlier
filed local Philippine application existing in the records of IPOPHL.
IX.

Applicant(s) – This is/These are the owner(s) of the application. The applicant’s(s’) complete name(s) and address(es) shall beindicated. Mark the appropriate box to indicate whether the applicant is a small entity or a big entity. Any natural person or juridical
person is presumed to be a big entity unless a written statement to the contrary is submitted by such natural person or the duly
authorized representative of such juridical person. (Section 3 (c) of Office Order No. 128 Series of 2003)

X.

Inventors(s)/Maker(s) – Mark the appropriate box to indicate whether the inventor(s) or maker(s) are the same as those listed in theinternational publication or if there are changes to the list made after the international publication. Indicate in the box below the checkboxes additional inventor(s) or maker(s) or any changes relating to the name(s) and/or address(es) of the inventor(s) or maker(s).

XI.

Checklist – This shall contain the number of sheets of the different elements of the international application from which the Duty
Officer of the day shall compute the total number of sheets.

XII. Claims – For fee calculation purposes, the applicant shall specify the number of claims for which protection is sought. This is also
intended to clarify the set of claims from which prosecution of the present application shall be based in view of a series of possible
amendments to the international application which occurred prior to national phase entry.
XIII. Other Document(s) Included – Mark the appropriate box corresponding the document submitted together with the application.
XIV. Agent (if any) or Common Representative (if any) in the Philippines – This is the name and Philippine address of the person whowill prosecute the application for the applicant. An applicant who is not a resident of the Philippines shall appoint and maintain anagent or representative residing in the Philippines. (Revised IRR Rule 421)
XV. Signature or Applicant(s) or Agent over printed name(s) – This confirms the applicant’s intent, if applicable through its counsel, toenter the national phase. The Office may accept a hand-written signature; or the use of other forms of signature, such as a printed orstamped signature, or the use of a seal or thumb marks, instead of a hand-written signature, provided that where a seal or a thumbmark is used, it should be accompanied by an indication in letters of the name of the signatory. (Revised IRR Rule 505)

(Revision 01) (March 2015)