FEDERATIVE REPUBLIC OF BRAZIL
MINISTRY OF AGRICULTURE, LIVESTOCK AND FOOD SUPLY
SECRETARIAT OF AGRICULTURE DEVELOPMENT AND COOPERATIVISM
DEPARTMENT OF INTELLECTUAL PROPERTY AND AGRICULTURE TECHNOLOGY
NATIONAL PLANT VARIETY PROTECTION OFFICE
Annex I
APPLICATION FORM
(Consult the instructions)
DOCKET (do not write in this space)
Botanical name *:
Proposed denomination *:
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APPLICATION FORM
Proposed denomination *:
1. APPLICANT
(a) Name *
(c) Address *
State **
FOR OFFICIAL
USE ONLY
(b) Nationality *
City *
ZIP Code **
Country *
Telephone *
Fax
E-mail *
/
(d) Legal status **
CPFa:
[ ] Private Individual.
[ ] Business Entity. CNPJb:
.
.
.
.
/
-
Will a Legal Representative be used? *
[ ] No (item 2 below may be left blank)
[ ] Yes (fill in item 2 below)
2. LEGAL REPRESENTATIVE (with head office or residence in Brazil)
(a) Name *
(b) Legal status **
[ ]Private Individual. CPFa:
[ ]Business Entity. CNPJb:
.
.
.
.
/
-
(c) Address *
City *
State *
Telephone *
Fax
ZIP Code *
E-mail *
/
(d) Contact name
3. TAXON
(a) Botanical name *
(b) Common name *
4. VARIETY
(a) Proposed denomination *
(b) Breeder’s reference
5. PARTICIPATING BREEDER(S):
(a) The breeding program was conducted: *
[ ] by the applicant (in case of a private
[ ] by the following person(s):
individual)
Name *
Address *
(b) I hereby declare that I am not aware of any other breeder that might have
participated in the breeding program of the instant variety.
(c) Was the variety transferred by the person(s) who bred, or discovered and developed,
the variety to the applicant(s)? In affirmative case, inform the modality and submit
documentary evidence *:
[ ] No
[ ] Yes:
[ ] Assignment
[ ] Succession
[ ] Other:
(d) Country where the plant variety was bred: *
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APPLICATION FORM
(e) Is the candidate variety a GMO, obtained through genetic engineering techniques? *
6.(a) Was there previously filed abroad as application for the protection othe plant
variety? *
[ ] No (item below and item 7 may be left blank)
[ ] Yes (fill in Country/Intergovernmental Organization and item 7 below)
Country/Intergovernmental
Organization
Date
Application No.
Type
PBR [ ]
PLP [ ]
PAT [ ]
Other [ ]
Denomination or
breeder’s
reference
7. RIGHT OF PRIORITY
[ ] I do not wish to claim the benefit of priority relative to an application for protection of
his plant variety previously filed in another country
[ ]I wish to claim the benefit of priority relative to an application for protection of the
instant variety previously filed in:
Country / Intergovernmental Organization:
;
Date:
; Denomination:
; Type:
.
8. FIRST COMMERCIALIZATION OF THE VARIETY
(a) Was the variety offered for sale or commercialized in Brazil? *
[ ] No
[ ] Yes: Denomination:
; First commercialization in:
(b) Was the variety offered for sale or commercialized abroad? *
[ ] No
[ ] Yes: Country / Intergovernmental Organization:
; Denomination:
commercialization in:
; First
9. STATEMENT OF LIVE SAMPLE
I hereby declare, subject to the penalties provided in the Law Nr 9,456, April 25th, 1997,
that the live sample of the plant variety that constitutes the object of the instant
application is kept at the disposal of the National Plant Variety Protection Office of Brazil
(SNPC), in optimum conditions of conservation, in the following place:
Contact Name:
Address:
I further acknowledge that failure to fulfill this obligation shall entail the cancellation of
the Plant Variety Protection Certificate, pursuant to Article 42 of Law Nr 9,456, April 25th,
1997
10. TRADEMARK WAIVER *
[ ] The Applicant herein declares that at the time of execution of the present application,
he/she is a not beneficiary of the rights concerning a product or service trademark
associated with the field of plants, or the field of application of the plant variety or a
trademark with notoriety, for the denomination that is the subject of the instant
application.
[ ]The Applicant herein declares that at the time of execution of the present application,
he/she is the beneficiary of the rights of a product or service trademark associated with
the field of plants, or the field of application of the plant variety or a trademark with
notoriety, for the denomination that is the subject of the instant application, hereby
waiving the cited rights from the moment that he/she is granted the corresponding
Provisional Plant Variety Protection Certificate.
DOCUMENTS SUBMITTED TO SNPC
I hereby submit the following documents, together with the instant Official Form of
Application for Protection of Plant Varieties:
[ ] Technical Report 1
[ ] Table of descriptors of the plant variety 1
[ ] Copy of Evidence of payment of the filing fee of the application for protection. 1
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APPLICATION FORM
[
[
[
[
[
] Photograph(s) 2
] Powers of Attorney (as applicable)
] Evidence of transfer of rights (as applicable)
] Copy of the request of the right of priority (as applicable)
] Other(s):
1
mandatory documents;
mandatory for varieties of ornamental species and for other species, per the specific
instructions for performance of the DUS tests.
2
SWORN STATEMENT
I hereby declare that the plant variety presently submitted is distinct, uniform
(homogeneous) and stable, pursuant to Article 3rd of Law Nr. 9,456/97, and further
declare, subject to the penalties provided in the Law, that the information provided in the
forms and in the documents attached thereto is complete and correct and corresponds
to the plant variety described, which designation was formerly indicated, and that I am
aware that I am liable both in civil and criminal terms for the statements provided herein.
City, State, in (date).
(name)
Applicant/Legal Representative
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PLANT VARIETY PROTECTION APPLICATION FORM
INSTRUCTIONS FOR FILLING THE FORM
Signs:
* Mandatory filling Boxes.
** Mandatory filling Boxes only for brazilian individuals and business entities.
a
b
CPF = (In Brazil) Individual taxpayer registration number
CNPJ = (In Brazil) Corporate taxpayer registration number
When the form is filled by hand, use block capital letters, in that case, if the fields are not sufficient, use
supplementary page(s)
Use the format “dd/mm/yyyy” for informing dates (e.g.: 21/04/2008).
FIELD 1. Inform the name name, full address and CPF/CNPJa,b of the Applicant. If there is more than one
Applicant, list the names, addresses and CPF/CNPJ** of all of these, listing one of them in the appropriate
field and the remaining ones (with their data) in separate page(s), and attach such page or pages to the
instant Application.
FIELD 2. Inform the name or corporate name, CPF/CNPJ and the full address of the Legal Representative, which
must be domiciled in Brazil. When the Power of Attorney lists more than one Legal Representative, fill in with
the data of the one to whom the official correspondence should be addressed. If the Legal Representative is
a business entity, indicate in the field “Contact Name” the name of an individual for contact.
FIELD 3. Specify the botanical and common names of the plant variety, spelled as they are in the official
descriptors (check whether the specie is already included in the list of species under regime of protection in
Brazil).
FIELD 4. Inform the proposed denomination for the plant variety, and if different thereform, the breeder’s
reference. The proposed denomination should be compliant with the provisions of Law 9,456/97 and the
Decree 2,366/97 and complementary legislation.
FIELD 5. List the breeders (private individuals) that participated in the breeding program identifying the same and
informing their respective addresses (when different from the address of the Applicant). If the plant variety
was an object of transfer, inform the modality and submit documentary evidence. It should also be Informed
the country where the variety was bred.
FIELD 6. If the protection for the variety was previously applied for abroad, list all the applications, informing the
country and/or intergovernmental organization where the same were docketed, as well as the docket date,
the docket number and the proposed denomination for the plant variety.
FIELD 7. If there is claimed a right of priority, indicate the country where the first application for protection of the
variety was filed as well as the filing date and the denomination proposed at that stage. Furthermore, it should
be submitted, within up three months, copies of the documents used to file the first application, duly certified
by the department or authority to wich the same were submitted, as well as sufficient evidence to the effect
that the plant variety is the object of both applications is the same.In order to enjoy the said right, the delay
between the first application for protection and the instant application may not exceed twelve months.
FIELD 8. In affirmative, indicate the date of the first commercialization of the plant variety in Brazil and/or abroad
and the denomination used for that purpose.
FIELD 9. Inform the location where the live sample of the plant variety will remain at the disposal of the SNPC,
indicating the name of the individual/entity in charge of maintaining the same and the full address of that
individual.
FIELD 10. It shall be indicated, mandatorily, only one of the options.
In the field “DOCUMENTS SUBMITTED TO SNPC”, indicate the documents attached hereto and submit the same
together with the instant Application (in case of checking the option “Other”, list such documents and attach the
same hereto).
Inform the place and date of the filling of this PLANT VARIETY PROTECTION APPLICATION FORM and sign it.
The remaining pages should be signed by the applicant or the Legal Representative.
In case of doubt, please contact the Coordination of the National Plant Variety Protection (SNPC). Visit the website
www.agricultura.gov.br to obtain information on telephones, electronic addresses and contact address.