Form for the additional declaration by natural persons
for requests/applications and submissions
due to the 14th sanctions package against Russia
within the meaning of Article 5s(1) of Regulation (EU) 833/2014

As a natural person filing an IP application with the German Patent and Trade Mark Office, you must send this completed form to the German Patent and Trade Mark Office, see Notice of the President No. 1/2024. If the application is filed by joint applicants, each person must send this form.

The German Patent and Trade Mark Office will not process your IP application(s) if the additional declaration has not been made.

Official file number (if already known)

Personal and address data:

Last name, first name
Street, street number
Postcode	Town/City
Country (only required if the address is not in Germany)

Declaration:

I am a Russian national.	No	Yes (please answer the questions below)
I am resident in Russia.	No	Yes (please answer the questions below)

Additional questions if you have answered “Yes” to any of the above questions:

I am a national of a member state of the European Union, of a country member of the European Economic Area or of Switzerland.	Yes	No
I have a temporary or permanent residence permit in a member state of the European Union, in a country member of the European Economic Area or in Switzerland.	Yes	No
If you have a temporary residence permit, please provide the date of expiry:
I must, if so requested by the German Patent and Trade Mark Office, provide documents supporting the above information. During pending and future registration procedures, I must immediately notify the German Patent and Trade Mark Office of any changes to the above information without being requested to do so.
Place, date	Signature
Acting as (if applicable)

Please tick where appropriate.

The member states are Belgium, Bulgaria, Czech Republic, Denmark, Germany, Estonia, Ireland, Greece, Spain, France, Croatia, Italy, Cyprus, Latvia, Lithuania, Luxembourg, Hungary, Malta, Netherlands, Austria, Poland, Portugal, Romania, Slovenia, Slovakia, Finland and Sweden.

The European Economic Area (EEA) includes the 27 EU member states and the three member states of the European Free Trade Association (EFTA) (Iceland, Liechtenstein and Norway).