BELGIAN COORDINATED COLLECTIONS OF MICROORGANISMS
BCCM/IHEM-COLLECTION
Form BCCM/IHEM/BP/12/................ Request for the furnishing of samples of deposited microorganisms pursuant to Rule 11.3(a) (Fill out in duplicate)

Send to:

Belgian Coordinated Collections of Microorganisms (BCCM)
Institut Scientifique de la Santé Publique - Louis Pasteur (IHEM)

Section mycologie
J. Wytsmanstraat 14 Rue J. Wytsman

B-1050 Brussels, Belgium

The undersigned hereby requests the furnishing of a sample of the microorganism identified hereunder, in accordance with Rule 11.3(a) of the Regulations under the Budapest Treaty

I. Identification of the microorganism:

Accession number of the deposit:

 

II. Patent application or patent referring to the microorganism

Remark:

 

References to a "patent" shall be construed as references to patents for inventions, inventors’ certificates, utility certificates, utility models, patents or certificates of addition, inventors’ certificates of addition, and utility certificates of addition.

Patent application

No. :
filed on :
Filed by (name, address) :

International application (PCT)

No. :
filed on :
Filed by (name, address) :

Patent

No. :
granted on :
Granted to (name, address) :

III. Request for information

The undersigned

 

requests

does not request

an indication of the conditions which the international depositary authority employs for the cultivation and storage of the microorganism.

IV. Certified party

Name :

 

Address :

 

Signature :

 

Where the signature is required on behalf of a legal entity, the typewritten name(s) of the natural person(s) signing on behalf of the legal entity should accompany the signature(s).

Date :

CERTIFICATION

It is hereby certified that:

the patent application specified under II above, referring to the deposit of the microorganism identified under I above, has been filed with this Office for the grant of a patent and its subject matter involves the said microorganism or the use thereof

 

the international application specified under II above, referring to the deposit of the microorganism identified under I above, designates for the grant of a patent the State party to the Patent Cooperation Treaty (PCT) for which this Office is the "designated Office" within the meaning of the said Treaty, and the subject of that international application involves the said microorganism or the use thereof

 

the patent specified under II above, referring to the deposit of the microorganism identified under I above, has been granted by this Office and its subject matter involves the said microorganism or its use thereof

 

publication for the purposes of patent procedure has been effected

 

(if only one box applies, mark that box with a cross; if both boxes apply, choose one of the boxes)

by this Office

by the International Bureau of the World Intellectual Property Organization as an international publication under the Patent Cooperation Treaty (PCT)

or

 

the certified party has a right to a sample before publication in accordance with (cite the applicable provision of the law, including any court decision):

 

the certified party has a right to a sample of the microorganism identified under I above under the law governing patent procedure before this Office and this Office is satisfied that the conditions, if any, prescribed by the said law have actually been fulfilled

 

or

 

the certified party has affixed his signature on a form before this Office and, as a consequence of the signature of the said form, the conditions for furnishing a sample of the microorganism identified under I above to the certified party are deemed to be fulfilled in accordance with the law governing patent procedure before this Office

 

Industrial Property Office :

Street :

City :

Country :

Signature :

Date :