在外者

Fill out the form completely.
Only alphabet/Kanji (Chinese character) is available.
在外者
Attach patent revenue stamps in the bottom of the form.
【あて先】
特許庁長官殿
[Address to]
【書類名】
特許料納付書
[Document title]
【提出日】
[Filing date]
【特許番号】
特許第
号
[Patent Number]
【特許権者】 [P a te n te e ]
【氏名又は名称】[Patentee’s Name]
【納付者】 [P a ye r ]
【住所又は居所】[Payer’s Address]* Please include your country and post code.
【氏名又は名称】[Payer’s Name]
【代表者】[Name of Representative of Legal Entity] *available only in the case of legal entity
【請求項の数】
[Number of claims]
【納付年分】
第
年分から第
年分
[Year]* In case that you want to pay the fees for some years in a lump sum, please indicate
the year as follows; 第 10 年分から第 12 年
Please provide us your contact information.
Fax number:
E-mail Address:
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(
JPY ）
A
Please attach patent revenue stamps here.

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