Annex A

FORM FOR REQUESTING THE SERVICES OF THE pATlIB CENTRE/ DOCUMENTATION CENTRE OF SARDEGNA rICERCHE 

I, the undersigned	
Born in 	Province (or foreign country)	
TIN no./VAT no. _______________________resident in _______________Prov. (country)	
Address _________________ Postcode ________________ e-mail 	
position  	
company/research centre 	
Activity sector 	
ISTAT code of activity sectors 	
HEREBY REQUEST 

access to the following services: 

 PATENT SEARCH 	
 PATENT MONITORING AND IDENTIFICATION	
 TRADEMARK SEARCH	
 DOCUMENT SEARCH	
 OTHER - (specify) 	

Brief description of the subject matter covered by the request	

	

Keywords	

Application sector(s)	

AND DECLARE AS FOLLOWS

•	I have read the Regulation on the delivery of services by the PatLib Centre/Documentation Centre of Sardegna Ricerche;
•	I/the organisation ______________________________ possess/possesses the requirements set out in the above mentioned "Regulation" and meet/meets all conditions for access to the facilities set out in the Regulation;
•	I exempt SARDEGNA RICERCHE from any liability arising from any breaches of industrial property protection legislation.

NOTICE pursuant to article 13 of Legislative Decree 196/03 (Italian Personal data protection code)
Pursuant to article 13 of Legislative Decree 196/03, we wish to inform you that:
•	The data provided will be processed by means of manual and IT tools, for purposes associated with the services delivered directly by SARDEGNA RICERCHE, respecting the data security and privacy rules laid down in the law quoted, also in the event of their disclosure to third parties.
•	Your data may be communicated to other SARDEGNA RICERCHE centres located in the Region, for official purposes linked to the agency’s activities. 
•	Pursuant to article 13, para 1 letters b) and c) of Legislative Decree 196/03, we wish to inform you that you have no legal obligation to authorise SARDEGNA RICERCHE to process your data, but failure to grant such authorisation could prevent SARDEGNA RICERCHE from delivering the services you request. 
•	You also have the rights set forth in article 7 of Legislative Decree 196/03, in particular you have the right to be informed of the source of the data, and of the logic and purposes of processing. You also have the right to obtain erasure, anonymization or blocking of data that have been processed unlawfully, as well as updating or integration of data, where interested therein. 
•	The Data controller is SARDEGNA RICERCHE, with registered office in Cagliari, Via Palabanda no. 9 (09123) and main place of business in Pula (CA), loc. Piscinamanna (09010).

I am fully aware of the legal consequences, including criminal liability, of making false statements, and I HEREBY DECLARE that the information provided in this form is true.

Date__________________________

Signature of applicant
 
													 					               ______________________

Address for correspondence:
Name _______________________________organisation 	
address __________________________postcode ______city __________________________
Province (or foreign country) ___________tel. ___________________ fax 	______
E-mail _____________________________________________________________________