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Description - Figure 5: Representative in Canada Information

This figure is a snapshot of the Representative in Canada Information. The figure consists of 16 segments. From top to bottom and left to right, the first segment has the text ‘D.-REPRESENTATIVE IN CANADA (Only required where Address in “A” is not in Canada). Below this, there is one segment with the text ’38.Representative in Canada same as Contact’ with a dropdown menu button.

Below this, there are 4 segments. The texts are ’39.Name*’ with a dropdown menu button, ‘Surname*’, ‘Given Name*’, ’40.Title’, and ’41.Language preferred:*’ with a dropdown menu button. Below this, there is one segments.  The texts are ‘42.Company Name (*if different from Applicant/Licensee)*’. Below this, there is 1 segment with the text ’44.Street/Suite/PO Box*’.  Below this, there are 4 segments with the texts ’45.City-Town*’, ’46.Country*’ with a dropdown menu button, ’47.Province-State*’ with a dropdown menu button, and ‘48.Postal/ZIP Code*’. Below this, there are 4 segments with the texts ’49.Telephone No.*’, ‘Ext.’, ’50.Fax No.*’, and ’51.E-mail*’.