Name of the authority that has charged the state fee	Location

APPLICATION
for the refund of state fee No. __________

Name and surname of the person requesting refund, name of a legal person
Chaillot Denis
Cabinet Chaillot	National identification code / registry code	Date of submission of the application for return
26/07/2024	

1. Place and date of the payment of the state fee

Name of the bank from which the payment was made

CIC NANTERRE ENTREPRISES	Account number of the payer of the state fee from which the payment was made
FR76 3006 6109 1500 0100 3260 115	Date of payment

02/07/202	

2. Place of the receipt of the state fee

Name of the bank

AS SEB PANK
	Account number

EE891010220034796011	Reference number

EP3326728 - 10th annuity	

Name of the operation for which the state fee is to be refunded
Annuity fee for Estonian part of European patent EP3326728
	Amount of the state fee

205 EUR	Refund basis

Overpayment of the annuity fee (paid 250 EUR instead of 205 EUR)	

3. Place and amount of the refund of the state fee

Name of the bank
CIC NANTERRE ENTREPRISES
	Account number
FR76 3006 6109 1500 0100 3260 115	Amount of refund

45 EUR	
Name of the account owner
CABINET CHAILLOT SARL
	National identification code / registry code
(Bank Identifier Code)
CMCIFRPP		

4. Contact details of the applicant

Address

16/20 avenue de l’Agent Sarre
92700 Colombes
France
	Phone

+33 1 41 19 27 77	E-mail

cabinet@chaillot.com	Signature

5. Data check

Data checked by

	Date	Phone	Signature