FORM 5
THE PATENTS ACT, 1970
(39 of 1970)
DECLARATION AS TO INVENTORSHIP
[See rule 14 (5) ]

I/We1………………………………………………………………………………………
Hereby declare that the true and first inventor (s) of the invention disclosed in the complete specification filed in pursuance of my/our application numbered…………….. dated………… is/ are2 :
(a) 3……………………………………………………………………………………
(b) 4……………………………………………………………………………………
(c) 5……………………………………………………………………………………
Dated this……….day of 19…………./20…………..
Signature6
(               )7
If any person named as inventor at above is not so named in the application, he must sign the following statements:-
I assent to the invention referred to in the above declaration, being included in the complete specification filed in pursuance of the stated application.
Signature 8
(               )7
To
The Controller of Patents,
The Patent Office,
At………………..
Note: Strike out whichever is inapplicable.
1.  Name (s) of the applicant (s)
2.  Repeat the columns (a) to (c) if there are more than one inventor.
3.  Insert the name in full. The family name or principal name in the beginning
4.  Insert the complete address.
5.  Insert the nationality.
6.  To be signed by the applicant or his authorised registered patent agent.
7.  name of the natural person who has signed.
8.  To be signed by the inventor.