FORM 21
THE PATENTS ACT, 1970
(39 of 1970)
&
The Patent Rules, 2003
REQUEST FOR TERMINATION OF COMPULSORY LICENCE
[See section 94; rule 102 (1)]
- Name, address, and nationality of applicant(s).
- Certified copies of the documents are to be enclosed in duplicate.
- A complete address including postal code and state along with telephone and fax number(s).
- To be signed by the applicant(s) or by his authorized registered patent agent.
- Name of the natural person who has signed.
I/We1 ...…...………………………………………….. hereby apply for the termination of the compulsory license granted to ……………. by the order of the Controller dated ………………….. under Patent No. …......... dated …………. granted to ……………. for which the patentee ………………….
I/We declare that I am/We are the patentee for the above-mentioned patent.
I/We declare that I/We derive title /interest in the patent. I/We make the above-mentioned request for termination on the following grounds, namely: ………………………………………………………
I/We declare that the facts and matters stated herein are true to the best of my /our knowledge, information and belief.
The details of documentary evidence in support of my/our interest and the grounds stated above are given below:2
(a) .........................................................................
(b) .........................................................................
(c) .........................................................................
My/Our address for service in India is:3 …………………………………………
Dated this ………………… day of ………. 20……
Signature4
(…………………………)
To
The Controller of Patents,
The Patent Office,
At……………………….
Note: - (a) For fee: See the First Schedule.
(b) Strikeout whichever is not applicable.
