Form Pct/ib/375 - Supplementary Search Request Page 5

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PCT
FEE CALCULATION SHEET
Annex to the supplementary search request
For International Bureau use only
AUTHORITY
International
application No.
Applicant’s or agent’s
Date stamp of the International Bureau
file reference
Applicant
CALCULATION OF PRESCRIBED FEES
SS
1. Supplementary search fee ...........................................
SH
2. Supplementary search handling fee ............................
0.00
3. Total of prescribed fees ..............................................
TOTAL
MODE OF PAYMENT
authorization to charge current account with the International Bureau (see below)
cheque
postal money order
bank transfer
credit card (details should not be indicated here but furnished to the International
Bureau on Form PCT/IB/380)
AUTHORIZATION TO CHARGE (OR CREDIT) CURRENT ACCOUNT WITH INTERNATIONAL BUREAU
Current Account No.: ___________________________
Authorization to charge the total fees indicated above.
Date: ________________________________________
Authorization to charge any deficiency or credit any
overpayment in the total fees indicated above.
Name: _______________________________________
Signature: ____________________________________
Form PCT/IB/375 (Annex) (January 2009)
See Notes to the fee calculation sheet

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