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This is a Cooley IP Forms form that can be used for International Preliminary Examining Authority within US Patent Office, PCT.
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PATENT COOPERATION TREATY From the INTERNATIONAL PRELIMINARY EXAMINING AUTHORITY To: PCT NOTIFICATION CONCERNING PAYMENT OF THE PRELIMINARY EXAMINATION AND HANDLING FEES (PCT Rules 57 and 58 and Administrative Instructions, Section 615) Date of mailing (day/month/year) Applicant's or agent's file reference PAYMENT DUE see item 3 for time limit International application No. International filing date (day/month/year) Applicant 1. The applicant is hereby notified that this International Preliminary Examining Authority has received: the payment of all the prescribed fees, and an overpayment, which will be refunded in due course. no or insufficient payment of the prescribed fees and the applicant is hereby invited to pay the balance due, as summarized under item 2, within the time limit indicated under item 3. 2. Fees and payment calculation: Preliminary examination fee Handling fee* P _____________________ H + _____________________ Total fees payable = _____________________ ______________________ = ___________________________ Amount paid Balance * Applicants from certain States are entitled to a reduction of 75% of the handling fee. Where the applicant is (or all applicants are) so entitled, the amount to be entered at H is 25% of the handling fee. See Notes to the Fee Calculation Sheet annexed to the Demand Form, PCT/IPEA/401, for details. 3. Time limit for payment and amount payable (Rules 57.3 and 58.1(b)): within ONE MONTH from the date on which the demand was submitted (see below), in which case the amount payable is the amount applicable on that date of submittal: __________________________________ within ONE MONTH from the date of receipt (see below) of the demand by this Authority (where the demand was transmitted to this Authority under Rule 59.3), in which case the amount payable is the amount applicable on that date of receipt: __________________________________ Name and mailing address of the IPEA/ Authorized officer Facsimile No. Form PCT/IPEA/403 (July 1998; reprint January 2004) Telephone No. American LegalNet, Inc. www.USCourtForms.com