Form 15

THE PATENTS ACT, 1970

(39 of 1970)

THE PATENT RULES 2003

APPLICATION FOR RESTORATION OF PATENT

(See Section 60 and Rule 84)

We, {{applicantNames}}, hereby apply for an order of the Controller for the Restoration of Patent No. {{patentNumber}} dated {{grantDate}} granted to Application No. {{applicationNumber}} titled "{{inventionTitle}}".

The circumstances which led to the failure to pay renewal fee for {{renewalYear}} on or before {{renewalDueDate}} are as follows:

{{reasonForFailure}}

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We declare that we have not assigned the patent to any other person(s) and that the facts and matters stated herein are true to the best of my/our knowledge, information and belief.

We, therefore, respectfully request that the patent be restored under Section 60 of the Patents Act, 1970, and undertake to pay all outstanding renewal fees along with the prescribed additional fee for restoration as required.

Dated this {{form15DateFormatted}}