(nw 34)] SOT | SET s FORM 3 THE PATENTS ACT, 1970 (39 of 1970) & The Patents Rules, 2003 STATEMENT AND UNDERTAKING UNDER SECTION 8 (See section 8, rute 12) 1. Namely of the applicant(s). IWe. hereby declare: 2. Name, address and nationality (0 that IWe have not made any application for the of the joint applicant: soralvotanialy te rae invention ou na, {that Ie who have made this application fo, Dated. alonejcintly wah : ‘made for the samalsubstantialy same invention, application(s) for patent in the other countnes, the particulars of which are given below: Name of the county Date of Application Status of the Dateof Date of, ‘No. application ‘application — publication grant 3. Name and address of the Gi) that the rights in the apptication(s) has/shave assignee been assigned to, a that We undertake that upto the date of grant of the patent, by the Controller, We would keep him informed in writing the details regarding corresponding applications for patents filed outside India within three months from the date. Of fling of such application. Dated this day of... 20 4, To be signed by the applicant or his authorised registered patent agent ‘Signature *. 5.Name of the natural person who ( y has signed. To The Controller of Patents, ‘The Patent Office, At trike out whichever is not applicable.