SINGAPORE PATENTS ACT (CHAPTER 221)
PATENTS RULESPATENTS FORM 15

Payment of Renewal Fee
and Any Additional Fee

Pre-requisites:.
a. Renewal fees are payable only after a patent has been granted.
b. This form should be filed only if you are renewing a patent that has not endorsed with licence as of right. If you wish torenew a patent which has been endorsed with licence as of right, please file Patents Form 53 instead.
Estimated Time:
This form may take approximately 9 - 13 minutes to complete.
General:a. * denotes mandatory fields.
b. Please note that you will not be receiving any acknowledgement from the Registry upon the lodgement of this form. Kindlycheck the renewal application status at IP2SG portal within 2 weeks.
c. 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 3

Title of Invention
Name of Proprietor*

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

Details of Person Seeking to Renew the Patent

Note: If the person(s) filing this request is/are the proprietor(s) mentioned in part 3 above, this part is to be left empty. If there isinsufficient space, please use the continuation sheet CS 1.

UEN/ Company Code(if applicable)

Name

Address

Singapore AddressThis Singapore address is to be used as the address forV1.20170401

Page 1 of 5

service for the purposes of this form.
(Note: If this is crossed, it is not necessary to fill up the address for service inSingapore in part 6.)

Block/ House
No.
Street Name
Level - Unit-Building
Name
Postal CodeForeign AddressLine 1Line 2
Line 3Nationality or Country ofIncorporation*
State of Incorporation(mandatory for USAcorporations)

Country of Residency(mandatory for individuals)

Sole Proprietor orPartners' Name
(if sole proprietorship orpartnership)

PART 5

Details of Renewal*

Note:a. Please cross the first checkbox if the patent is granted after the expiry of 45 months from the date of filing of the patentand this is the first time you are making payment of renewal fee for your patent.
b. Please indicate the anniversary of the patent for which renewal is sought, e.g. 11th.
c. If this form is filed after the relevant deadline for making payment of renewal fees but within 6 months of this deadline, anadditional fee is payable on top of renewal fees. Please indicate the number of months that this form is filed late in the box
provided.

Details of Renewal

Payment of renewal for preceding years
fromyeartoyearwithV1.20170401

month(s) payment of additional fee

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Payment of renewal for succeeding year
foryearwithmonth(s) payment of additional fee

Payment of balance of all renewal fees payable due tocancellation of licence of rights (via PF28)

PART 6

fromyeartoyearContact 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 address for service in Singapore need not be filled up if the person's address in Part 4 is to be used as an address forservice in Singapore.
c. For the purpose of renewal and/or restoration, the official correspondence will be sent to the address for service inSingapore as indicated in this box.

Agent UEN/ Company
Code
Agent Name

Representative or C/O
Name
Address for Service in Singapore
Block/ House
No.
Street Name
Level - Unit-Building
Name
Postal CodeContact Person(if applicable)

Direct Telephone No.
(if applicable)

V1.20170401

Page 3 of 5

Email Address(if applicable)

PART 7

Declaration*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.

NameSignatureDate(DD/MM/YYYY)

No. of Extra Sheets
Attached to this Form

V1.20170401

sheet(s)Page 4 of 5

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 Proprietor (as in Part 3 of this form) should be inserted in this field.

Name (Tax invoice to beissued to)V1.20170401

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