SINGAPORE PATENTS ACT (CHAPTER 221)
PATENTS RULESPATENTS FORM 57

Addition, Correction or Late Declaration of Priority

Pre-requisites:
a. If you are requesting for permission to make a late declaration of priority under rule 9A(2) together with a request for apriority declaration to be added under rule 9(2) or a request for a correction of previously made priority declaration underrule 9(3), the fee for each request type is payable.
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
IPOS Reference(if applicable)

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

Priority Details*

Indicate below the details of the priority application relevant to this declaration/request.

Country

Application No.
(if applicable)

Filing Date
(DD/MM/YYYY)

V1.20170401

Page 1 of 4

PART 5

Type of Declaration or Request*

Type of Declaration orRequest*(Note:Cross only onecheckbox)

A priority declaration under Rule 9(2)A request under Rule 9(3) to correct a mistake in a priority
declaration
A request under Rule 9A(2) for permission to make a latepriority declaration
A priority declaration under Rule 9(2) and a request under Rule9A(2) for permission to make a late priority declaration
A request under Rule 9(3) to correct a mistake in a priority
declaration and a request under Rule 9A(2) for permission tomake a late priority declaration

PART 6

Reason for the Failure to File the Application in Suit Within the Period Referred toin Section 17(2A)(a)Note: This Part is to be completed if in Part 5 a request is made under rule 9A(2) for permission to make a late priority
declaration.

Reason(Note:Cross only onecheckbox)

Occurred in spite of due care required by the circumstanceshaving been taken
Unintentional

Detailed Explanation ofthe Reason is Indicatedin this Box or in theCopy of the Evidence
Filed with this Form.

PART 7

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/ CompanyCodeAgent Name

Representative or C/OName

V1.20170401

Page 2 of 4

Address for Service in Singapore
Block/ House
No.
Street Name

Level - Unit

-Building
Name
Postal CodeContact Person(if applicable)

Direct Telephone No.
(if applicable)

Email Address(if applicable)

PART 8Declaration*
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 AgentI, 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

Page 4 of 4