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(Section 47 of the Patent Act)
Application for Reissue
1. The patentee of Patent No.______________________, granted on ______________________ for an invention entitled __________________________________________________________________
requests that a new patent be issued, in accordance with the accompanying amended specification, for the unexpired term for which the original patent was granted and agrees to surrender the original patent effective on the issue of a new patent.
2. The name and complete address of the patentee is ______________________
3. The respects in which the patent is deemed defective or inoperative are
4. The error arose from inadvertence, accident or mistake, without any fraudulent or deceptive intention, in the following manner:
5. The knowledge of the new facts giving rise to the application were obtained by the patentee on or about ______________________ in the following manner:
6. The patentee appoints ______________________,
whose complete address in Canada is ______________________
as the patentee's representative in Canada pursuant to section 29 of the Patent Act.
7. The patentee appoints ______________________,
whose complete address is ______________________
as the patentee's patent agent.
In sections 2, 6 and 7, names and addresses must be presented in the following order with a clearly visible separation between the various elements: family name (in capital letters), given name(s), initials, or firm name, street name and number, city, province or state, postal code, telephone number, fax number and country.