FORM 1

(Section 47 of the Patent Act)

Application for Reissue

1. The patentee of Patent No. __________, granted on __________ for an invention entitled __________, requests that a new patent be issued, in accordance with the accompanying amended specification, for the unexpired term for which the original patent was granted and agrees to surrender the original patent effective on the issue of a new patent.

2. The name and complete address of the patentee is __________.

3. The respects in which the patent is deemed defective or inoperative are________________
__________________________________________________________________________.

4. The error arose from inadvertence, accident or mistake, without any fraudulent or deceptive intention, in the following manner:______________________________________________
__________________________________________________________________________.

5. The knowledge of the new facts giving rise to the application were obtained by the patentee on or about __________ in the following manner:_____________________________________
__________________________________________________________________________.

6. The patentee appoints _______________, whose complete address in Canada is
_________________________, as the patentee's representative in Canada pursuant to section
29 of the Patent Act.

7. The patentee appoints ___________________, whose complete address is
____________________, as the patentee's patent agent.

Instructions

In sections 2, 6 and 7, names and addresses must be presented in the following order with a clearly visible separation between the various elements: family name (in capital letters), given name(s), initials, or firm name, street name and number, city, province or state, postal code, telephone number, fax number and country.