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European Patent Of ce Treasury and Accounts 80298 M nchen Germany Fax 49 0 89 2399-4465 Payment of fees and expenses Please complete in typescript only Payer s reference Name of payer Mode of payment Name of bank where EPO account held Bank payment /transfer to 1 Address Deposit account No. Debit from deposit account with the EPO is requested 2 Patent application / patent No. please use a separate form for each application 03 EP Code Currency Fil.

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