(here state exact interest of the disclaimant and, if an assigneee, set out the liber and page or reel and frame where the assignment is recorded)

of application Serial No. filed on the day of 19- for I

hereby disclaim the terminal part of any patent granted on the above-identified application, which would extend beyond the expiration date of Patent No. and hereby agree that any patent so granted on the above-identified application shall be enforceable only for and during such period that the legal title to said patent shall be the same as the legal title to United States Patent No. this agreement to run with any patent granted on the above-identified aplication and to be binding upon the grantee, its successor or assigns.

1. [ ] Enclosed is a copy of the prior application, including the oath or declaration as originally filed.

I hereby verify that the attached papers are a true copy of prior application Serial No. as originally filed on (date), and further that this statement was made with the knowledge that willful false statements and the like so made are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code, and that such willful false statements may jeopardize the validity of the application or any patent issuing there

4. The Commissioner is hereby authorized to charge any fees which may be required, or credit any overpayment to Account No. A duplicate copy of this sheet is enclosed.

5. [ ] A check in the amount of $ is enclosed.

6. [ ] Cancel in this application original claims of the prior application before calculating the filing fee. (At least one original independent, claim must be retained for filing purposes.)

7. [ ] Amend the specification by inserting before the first line the sentence:- This is a [] continuation, [ ] division, of application serial no. ——, filed

8. [] Transfer the drawings from the prior application to this application and abandon said prior application as of the filing date accorded this application. A duplicate copy of this sheet is enclosed for filing in the prior application file. (May only be used if signed by person authorized by § 1.138 and before payment of base issue fee.)

8a. [] New formal drawings are enclosed. 8b. [ ] Priority of application serial no. filed on in (country), is claimed under 35 U.S.C. 119.

9. [] The prior application is assigned of record to

10. [ ] The power of attorney in the prior application is to (name,

registration number, and address).

a. [] The power appears in the original papers in the prior application.

b. [] Since the power does not appear in the original papers, a copy of the power in the prior application is enclosed.

c. [ ] Address all future communications (May only be completed by applicant, or attorney or agent of record.)

described and claimed in international ap

plication No. amended on

(if any), which I have reviewed and for which I solicit a patent; I do not know and do not believe the same was ever known or used in the United States of America before my or our invention thereof, or patented or described in any printed publication in any country before my or our invention thereof or more than one year prior to my international application, that the same was not in public use or on sale in the United States of America more than one year prior to my international application, that the intention has not been patented or made the subject of an inventor's certificate issued before the date of my international application in any country foreign to the United States of America on an application filed by me or my legal representatives or assigns more than twelve months prior to any international application, that I acknowledge my duty to disclose information of which I am aware which is material to the examination of this application, and that no application for patent or inventor's certificate on this invention has been filed in any country foreign to the United States of America prior to this application by me or my legal representatives or assigns except as follows:

§3.57 Declaration to be filed with United Stated Designated Office under 35 U.S.C. 371(c)(4).

As a below named inventor, I hereby declare that:

My residence, post office address and citizenship are as stated below next to my name;

I verily believe I am the original, first and sole inventor (if only one name is listed below) or a joint inventor (if plural inventors are named below) of the invention entitled:

described and claimed in international application No. filed and as amended on (if any), which I have received and for which I solicit a patent; I do not know and do not believe the same was ever known or used in the United States of America before my or our invention thereof, or patented or described in any printed publication in any country before my or our invention thereof or more than one year prior to my international application, that the same was not in public use or on sale in the United States of America more than one year prior to my international application, that the invention has not been patented or made the subject of an inventor's certificate issued before the date of my international application in any country foreign to the United States of America on an application filed by me or my legal representatives or assigns more than twelve months prior to my international application, that I acknowledge my duty to disclose information of which I am aware which is material to the examination of this application, and that no application for patent or inventor's certificate on this invention has been filed in any country foreign to the United States of America prior to this application by me or my legal representatives or assigns, except as follows: