Patent Office - Request for the Registration of a Transfer

Patent Office - Request for the Registration of a Transfer (PDF - 141 KB - 5 pages)

instructions for the Request for the Registration of a Transfer

Failure to complete all the sections of the form may result in the registration not being completed. Telephone, fax, and e-mail are optional

1. Request for Registration

Registration of the following change in ownership is hereby requested. It is understood that it is the requestor's responsibility to include in the form all the information required for the registration of the transfer and ensure the accuracy of the included information.

2. Patent Applications and/or Patent(s) Concerned

List of patent applications and/or patent(s)
Client's reference number	Application of patent number (Canadian number or PCT number)	Title (Optional)

(Optional) Information regarding further application(s) and/or patent(s) concerned is provided on additional sheet N^o ____

3. Basis for Transfer

The transfer resulted from:

an assignment
a merger
other (specify): _____________________

The transfer was effective on :

Date (yyyy-mm-dd): _____________________, or
before the filing date

The original document, a copy of the original document or the pertinent extract is enclosed.

4. Extent or Scope of the Transfer

The interest owned by the transferor/assignor is transferred in:

whole
part

(Optional) Further information is provided on additional sheet N^o ____

5. Proof of the Transfer

For the purposes of section 49 or section 50 of the Patent Act, the following proof accompanies the request:

an affidavit; or
a document showing that the assignment or transfer was registered in a patent office of another country; or
if the change in ownership relates to a patent application, the following statement from the requestor or from a witness: "to the knowledge of the author of this statement, the document effecting the transfer was signed and the transfer was executed by the transferor/assignor"; or
if the change in ownership relates to a patent, the following statement from the requestor or from a witness: "to the knowledge of the author of this statement, the document effecting the transfer was signed and the transfer was executed by all parties"; or
presence of the signature of a witness or presence of a corporate seal on the assignment or transfer document; or
other (specify): _____________________________

6. Transferor(s)/assignors

Name and complete address:
(Family name followed by given name; for any other legal entity, full official designation.)

Telephone N^o:

________________

Fax N^o:

________________

E-mail:

________________
Name and complete address:
(Family name followed by given name; for any other legal entity, full official designation.)

Telephone N^o:

________________

Fax N^o:

________________

E-mail:

________________

(Optional) Information regarding further transferor(s)/assignor(s) is provided on additional sheet N^o: ____

7. Transferee(s)/assignee(s)

Name and complete address:
(Family name followed by given name; for any other legal entity, full official designation.)

Telephone N^o:

________________

Fax N^o:

________________

E-mail:

________________

(Optional) This transferee/assignee should not be indicated as current owner in CIPO's record (This transfer/assignment was followed by at least one other transfer/assignment.)
Name and complete address:
(Family name followed by given name; for any other legal entity, full official designation.)

Telephone N^o:

________________

Fax N^o:

________________

E-mail:

________________

(Optional) This transferee/assignee should not be indicated as current owner in CIPO's record (This transfer/assignment was followed by at least one other transfer/assignment.)

(Optional) Information regarding further transferor(s)/assignor(s) is provided on additional sheet N^o: ____

8. Prescribed fee

In accordance with Schedule 2 of the Tariff of Fees, a prescribed fee must be submitted for each document registered in the Office, per patent application/patent. Payment should be submitted at the same time using CIPO's Fee Payment Form.

Number of document(s) to be registered	______	x
Number of application(s)/patent(s) affected:	______	x
Prescribed fee ($):	100.00	=
Total ($):	______	$

9. Requestor information

the transferor/assignor/owner currently on record;
the transferee/assignee/new owner;
a representative acting on behalf of the transferor(s)/assignor(s);
a representative acting on behalf of the transferee(s)/assignee(s)
(This request does not constitute a formal appointment of agent).

If the request is submitted by a representative, please indicate name and complete address:
(Family name followed by given name; for any other legal entity, full official designation.)

Telephone N^o:

________________

Fax N^o:

________________

E-mail:

________________