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(for an international application filed under the Patent Cooperation Treaty)
(PCT Rule 90.4)

The undersigned applicant(s) (Names should be indicated as they appear in the Request Form (PCT/RO/101)):

hereby appoints (appoint) the following person as:


common representative

Name and address
(Family name followed by given name; for a legal entity, full official designation. The address must include postal code and name of country.)

to represent the undersigned before

all the competent International Authorities
the International Searching Authority only
the Authority specified for supplementary search only: ______________________
(please indicate the Authority(ies) specified for supplementary search)
the International Preliminary Examining Authority only

in connection with the international application identified below:
Title of the invention:

Applicant’s or agent’s file reference:
International application number (if already available):
filed with the f