FORM 5

THE PATENT ACT, 1970 ( 39 OF 1970 )

&

The Patents Rules, 2003

DECLARATION AS TO INVENTORSHIP

[See section 10(6) and Rule 13(6)]

I/We, {{applicantName}} having address at {{applicantAddress}}, hereby declare that the true and first inventors of the invention disclosed in the complete specification filed in pursuance of our Application No. {{applicationNumber}} dated {{form5Date}} is/are

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INVENTORS NATIONALITY ADDRESS
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On behalf of the Applicant

To,

The Controller of Patent

The Patent Office, at Chennai.