Micro Entity Certification Form

MICRO ENTITY CERTIFICATION FORM

This Micro Entity Certification Form (the "Certification") is entered into as of Effective Date: by Applicant Name: and Authorized Representative: .

Applicant Address:

RECITALS

WHEREAS, Applicant seeks to establish entitlement to micro entity status for the purpose of fee reduction in connection with patent filings and related proceedings;

WHEREAS, Applicant represents that the information set forth in this Certification is true, complete, and material to the fee status to be applied in connection with the relevant filing or proceeding;

WHEREAS, Authorized Representative has authority to sign on behalf of Applicant to attest to the representations contained herein.

NOW THEREFORE, in consideration of the mutual covenants and representations set forth below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Certification, the following definitions apply:

"Applicant" means the individual or legal entity identified above that seeks micro entity status. "Authorized Representative" means the individual authorized to sign this Certification on Applicant's behalf. "Material Change" means any change in circumstances that would cause the Applicant to no longer meet any representation contained in Section 2.

2. CERTIFICATION OF MICRO ENTITY STATUS

Applicant certifies, acknowledges, and warrants the truth of each of the following statements by checking the corresponding box and, where requested, providing supporting information:

Applicant's gross income, when calculated in accordance with applicable rules, is within the limits required for micro entity status and Applicant has not assigned, granted, or conveyed any rights in the invention to an entity whose gross income would disqualify Applicant from micro entity status.

Applicant has not been named as an inventor on more than four prior nonprovisional patent applications (excluding provisional applications, international applications, reissue applications, and design applications) as of the Effective Date.

Applicant has not assigned, licensed, or otherwise transferred an ownership interest in the invention to an entity that would prevent Applicant from qualifying as a micro entity.

Applicant meets any other factual criteria required for micro entity status under applicable patent rules and regulations as of the Effective Date.

3. REPRESENTATIONS AND WARRANTIES

Applicant represents and warrants that all statements made in this Certification are true and correct to the best of Applicant's knowledge and belief, and that Applicant will maintain records sufficient to substantiate the representations herein for the period required by applicable rules.

Applicant further represents that any fee reductions taken in reliance upon this Certification will be refunded and any additional fees will be paid promptly should it be determined that Applicant was not entitled to micro entity status.

4. DUTY TO NOTIFY

Applicant shall notify the relevant authority and Authorized Representative in writing of any Material Change within days of the occurrence of such change. The notice shall describe the nature of the change and include any facts necessary to assess continued eligibility.

5. ACKNOWLEDGMENT OF CONSEQUENCES

Applicant acknowledges that a false or knowingly incorrect statement in this Certification may result in civil or administrative remedies, including but not limited to denial of fee reductions, imposition of additional fees, and other sanctions permitted by law or rule.

Applicant agrees to indemnify and hold harmless Authorized Representative for any liabilities arising solely from Applicant's misrepresentation in this Certification.

6. NOTICES

7. RECORDS AND INSPECTION

Applicant shall retain documentation and records that substantiate entitlement to micro entity status for the period required by applicable rules and shall make such records available for inspection upon reasonable request by the relevant authority.

8. GOVERNING LAW

This Certification shall be governed by and construed in accordance with the substantive laws applicable to the underlying filing or proceeding, without regard to conflict of law principles.

9. ENTIRE AGREEMENT

This Certification constitutes the entire agreement between Applicant and Authorized Representative with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, whether written or oral, relating thereto.

10. SEVERABILITY

If any provision of this Certification is held to be invalid or unenforceable by a court of competent jurisdiction, the remainder of this Certification shall remain in full force and effect and such invalid or unenforceable provision shall be reformed to the minimum extent necessary to make it valid and enforceable.

11. AMENDMENT, WAIVER, COUNTERPARTS

No amendment or waiver of any provision of this Certification shall be effective unless in writing and signed by both Applicant and Authorized Representative. This Certification may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

12. ADDITIONAL INFORMATION

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