1	General authorisation	General authorisation No. (For official use only)
Please forward the original direct to the EPO, Legal Division (Dir. 5.2.4) in Munich. Please read the attached notes before completing the form.
2	I (We)	Full name and address of authorisor(s)
3	do hereby authorise	Potter Clarkson (Association 414) And legal practitioners G H Carr D J Holt L Karnøe M Kramer O A Laing N D McDonald M Nichols R A Roberts J Sellin Chapel Quarter Chapel Bar Nottingham NG1 6HQ United Kingdom	Full name and address of association of representatives.
4	to represent me (us) in all proceedings established by the European Patent Convention and to act for me (us) in all patent transactions.
X	This authorisation includes the power to receive payments on my (our) behalf.
X	This authorisation shall also apply to the same extent to any proceedings established by the Patent Cooperation Treaty.
5	X	Sub-authorisation may be given.
Additional representatives indicated on supplementary sheet.
6	X	Please return a copy, supplemented by the general authorisation number, to the authorisor.
Place	Name (printed)
Date	Position within the company (where relevant)
Signature*
7	*The form must bear the personal signature(s) of the authorisor(s). In the case of legal persons, the signature must be that of the person empowered to sign on behalf of the company. If possible, please sign in blue.
EPO 1004 12.07 1