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Ons Number of National Deposit Examiner code: Date of National Deposit Introduce in date bases Yes / No The application it will be completed by O.S.I.M. in 3 copies I (71) APPLICANT(S) (name, surname, comple te addr ess or name and center, te lepho ne, telex, fax) II (74) REPRESENTATIVE (name, surname, address or nam e and center, telephone, fax) III AUTHOR (S) (name, surname and address of the physical person who create the industrial design) IV I r.

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