APPLICATION FOR PATENT

The Director
Patent Office
Manila
Sir:
The undersigned hereby files a petition for the granting of a patent under the
provisions of R.A. No. 165, and states:
1. That he is a citizen of ________________, domiciled at _________________;
2. That he is the inventor of _____________, with the following:
(a) Specification
1. That the title of the invention herein sought to be patented is ___________;
2. That the nature and purpose of said invention is _____________________;
3. That the said invention is hereby represented by a drawing attached hereto, as
Annex A, and said drawings (or drawings) is (or are) briefly explained as follows
__________________________;
4. (Here make a complete and detailed description of the invention is such full,
clear, concise and exact terms as to enable any person skilled in the art or science to
which the invention relates to make and practice the invention);
5. That the said invention is entirely new and patentable under the Philippine
Patent Law.
________________________
(Signature of Inventor)
(b) Sworn Declaration
REPUBLIC OF THE PHILIPPINES )
CITY OF MANILA
) SS
_______________________, above applicant, being duly sworn, deposes and
says: That he is the true and actual inventor of the above-described: _______________
That said invention is new and is therefore patentable under the Philippine Patent
Law;

The said invention is not contrary to public order or morals, or to public health or
welfare;
That the specification and drawings thereto annexed are correct, and comply with
the requirements of the Patent Law.
________________________
(Signature of Inventor)

SUBSCRIBED and sworn to before me, in the city/municipality of

_______________, this _______ day of _____________, 200_ by ____________ with
Community Tax Certificate No. _________________ issued at ________________ on
__________, 200_.

NOTARY PUBLIC

Doc No. ______;

Page No. ______;
Book No. ______;
Series of 200__.