FORM 3

(Subsection 27(2) of the Patent Act)

Petition for Grant of a Patent

1. The applicant, ____________, whose complete address is ____________, requests the grant of a patent for an invention, entitled ____________, which is described and claimed in the accompanying specification.

2. This application is a division of application number ______, filed in Canada on __________.

3. (1) The applicant is the sole inventor.

(2) The inventor is ____________, whose complete address is ____________, and the applicant owns in Canada the whole interest in the invention.

4. The applicant requests priority in respect of the application on the basis of the following previously regularly filed application:

Country of filing			Application number   			Filing date
___________________		___________________		___________________
___________________		___________________		___________________

5. The applicant appoints ____________, whose complete address in Canada is____________, as the applicant's representative in Canada, pursuant to section 29 of the Patent Act.

6. The applicant appoints ____________, whose complete address is ____________, as the applicant's patent agent.

7. The applicant believes that the applicant is entitled to claim status as a "small entity" as defined under section 2 of the Patent Rules.

8. The applicant requests that Figure No. ____________ of the drawings accompany the abstract when it is open to public inspection under section 10 of the Patent Act or published.

Instructions

In section 1, subsection 3(2) and sections 5 and 6, 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.

In sections 5 and 6, appointment of representatives and appointment of patent agents may also be done in a separate document.

The applicant shall include in the petition either subsection 3(1) or (2).

Requests for priority may be done in section 4 of the petition or in a separate document.