Intellectual Property Regulation Board

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					                         Intellectual Property Regulation Board

     incorporating the Patent Regulation Board and the Trade Mark Regulation Board


                                                                           IN THE MATTER OF
                                                                      an Application for Entry
                                                           in the Register of Patent Attorneys
                                                                     or Trade Mark Attorneys

                                 STATUTORY DECLARATION

I,        [name]                        of [address]


do solemnly and sincerely declare as follows:


[Patent Attorney]

(a)    I have passed or been exempted from all of the Papers of the Qualifying
Examinations as set out in the Regulations for the Examination of Patent Agents & Trade
Mark Agents 1991 (as amended) and evidence of my examination passes and any relevant
dispensations are appended hereto.


[Trade Mark Attorney]

(a)     I have passed all of the Papers of the Qualifying Examinations as set out in the
Regulations for the Examination of Patent Agents & Trade Mark Agents 1991 (as amended)
and evidence of my examination passes are appended hereto.

[Both]

(b)     I have completed ______ (number) years full time practice in the field of intellectual
property, including substantial experience in [patent agency work][trade mark agency work],
and where that practice has been for less than 4 years it has been under supervision of a
person (‘Supervisor’) who meets the requirements of Regulation 4 of the Patent Attorney
and Trade Mark Attorney Qualification and Registration Regulations in accordance with the
following particulars:



Period                           Address(es) where                       Full name and
covered                          practice took place                     professional
                                                                         qualification of
                                                                         Supervisor(s)
__________                      _______________                       _______________
__________                      _______________                       _______________
__________                      _______________                       _______________


I have not been convicted of a criminal offence in any court or received a caution,
reprimand or warning in the UK or elsewhere in relation to an offence involving
dishonesty or violence, any offence associated with obstructing the course of justice
or the unauthorised use of a protected professional title, any racially motivated
offence, any sexual offence or any offence resulting in an actual or suspended term
of imprisonment.

In the past six years, I have not committed an act of plagiarism or cheating in any
form of professional or university assessment, had a County Court judgement or
High Court judgement for civil fraud placed against me, been censured, suspended
or the subject of any other disciplinary activity by a professional or regulatory body
and am not currently under investigation by such a body.

To the best of my knowledge and belief there are no other factors which may call
into question my character and suitability to become a registered patent or trade
mark attorney.

I have read the Rules of Conduct for Patent Attorneys, Trade Mark Attorneys and
other related persons adopted by the respective Patent Attorney Regulation Board
and the Trade Mark Attorney Regulation Board and agree to be bound by them.


AND I MAKE this solemn Declaration conscientiously believing the same to be true and by
virtue of the provisions of the Statutory Declarations Act, 1835.


Dated this             day of              20



(Signature) _________________________________



Before me:


_________________________________

Solicitor/Commissioner for Oaths

				
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posted:8/31/2012
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