PATENT.

£1.

(a) Here insert (in full) name, address, and calling of applicant or applicants.

PATENTS FORM No. 1.

PATENTS AND DESIGNS ACT, 1907.

(To be accompanied by two copies of Patents Form No. 2 or of Patents Form

No. 3.)

(a) I (or we).

APPLICATION FOR PATENT.

do hereby

declare that I am (or we are) in possession of an invention the title of which

(b) Here insert is (b).

title of inven

tion.

(c) In the case that (c).

of more than one applicant, state

here who is or are the inventor or inventors.

claim to be the true and first inventor

thereof; and that the same is not

in use by any other person or persons to the best of my (or our) knowledge and belief; and I (or we) humbly pray that a Patent may be granted to me (or us) for the said invention.

NOTE.-One of the two forms on the back hereof or a separate authoriza

tion of agent should be signed by the applicant or applicants.

To the Comptroller,

The Patent Office, 25, Southampton Buildings,

Chancery Lane, London, W.C.

(1.) Where application is made through an Agent (Rule 9).

of

I (or we) hereby appoint.

to act as my (or our) Agent in respect of the within application for a Patent, and request that all notices, requisitions, and communications relating thereto may be sent to such Agent at the above address.

(2.) Where application is made without an Agent (Rule 8).

I (or we) hereby request that all notices, requisitions, and communications

in respect of the within application may be sent to