LETTER OF ASSURANCE FOR ESSENTIAL PATENTS

Please return or FAX to:	Secretary, IEEE-SA Standards Board Patent Committee
			Institute of Electrical and Electronics Engineers, Inc.
			445 Hoes Lane
			Piscataway, NJ	08855	USA
			FAX (+1 732-875-0524)

                                       No license is implied by submission of this Letter of Assurance                   

A. Patent HOLDER/Organization:

Legal Name of Organization:	

B. PATENT HOLDER’S CONTACT FOR LICENSE APPLICATION:

Name & Department:		
Address:					
Telephone: ______________________ Fax: _________________ E-mail:	
URL:	___________________________________

C. IEEE STANDARD or PROPOSED IEEE STANDARD:

Number:  _________________________________
Title: ___________________________	

D. PATENT HOLDER'S POSITION REGARDING LICENSING ESSENTIAL PATENT RIGHTS:

If the Patent Holder owns or controls granted patent(s) and/or pending applications that it believes may be infringed by compliance with the Proposed IEEE Standard, please specify the patent number, published application, and/or relevant claims.  (A patent search is not required.)
	Patent Number(s) (if known):	

	Relevant Claims (optional):  __________________________________________________________

The Patent Holder states that its position with respect to licensing such patent(s) is as follows (check one box only):

          1. The Patent Holder is prepared to grant a royalty-free license to an unrestricted number of applicants on a worldwide, non-discriminatory basis and on reasonable terms and conditions to comply with the [Proposed] IEEE Standard.

          2. The Patent Holder is prepared to grant a license to an unrestricted number of applicants on a worldwide, non-discriminatory basis and on reasonable terms and conditions to comply with the [Proposed] IEEE Standard.

          3. The Patent Holder is unwilling to grant licenses according to the provisions of either 1 or 2 above.  

          4. The Patent Holder states that it will not enforce any of its present or future patent(s) whose use would be required to implement either mandatory or optional portions of the proposed IEEE standard against any person or entity complying with the standard.

          45. I am not aware of any patent(s) and/or patent claim(s) that my company may hold that would be relevant to the subject matter of the [Proposed] Standard.

E. SIGNATURE:

Print name of authorized person:	

Title of authorized person: _____________________________________________________________________ 

Signature of authorized person: __________________________________ Date: ___________________________

Note: This assurance applies from the date of the standard’s approval to the date of the standard’s withdrawal and is irrevocable during that period.