PTO/SB/101 Declaration and Power of Attorney for Patent Application

Doc Code: OATH
Document Description: Oath or declaration filed

PTO/SB/101 (07-09)
Approved for use through 09/30/2010. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.

Attorney Docket
Number
First Named Inventor

实用专利或设计专利申请声明
(37 CFR 1.63)
DECLARATION FOR UTILITY OR
DESIGN
PATENT APPLICATION
(37 CFR 1.63)
初次备案时提交的声明
Declaration Submitted
With Initial Filing

或者

OR

COMPLETE IF KNOWN
Application Number

初次备案后提交的声明（需

Filing Date

要支付附加费 (37 CFR

Art Unit

Examiner Name
1.16(f))）
Declaration Submitted After
Initial Filing (surcharge (37
CFR 1.16(f)) required)

本人兹此声明：(1) 每位发明人的住址、邮寄地址及公民身份即是下文他们姓名旁边所列出之信息；及
(2) 本人相信以下指明的发明人是本主题发明的最初和第一位发明人，该发明人对所标示的发明主张权利并要求获得专利：
I hereby declare that: (1) Each inventor’s residence, mailing address, and citizenship are as stated below next to their name; and
(2) I believe the inventor(s) named below to be the original and first inventor(s) of the subject matter which is claimed and for which a
patent is sought on the invention titled:

（发明名称）
(Title of the Invention)
该发明的申请
the application of which
如下所附
is attached hereto

或者 OR
于 (月/日/年)

备案为美国申请号码或 PCT 国际

申请号码

并于 (月/日/年)

was filed on (MM/DD/YYYY)
Application Number

as United States Application Number or PCT International
and was amended on (MM/DD/YYYY)
(if applicable).

修订（如适用）。

本人兹此声明本人已经审阅并理解根据上文参考的任何修订文件进行修订的上述规范内容，包括权利主张。
I hereby state that I have reviewed and understand the contents of the above identified specification, including the claims, as amended by any
amendment specifically referred to above.
本人承认有责任披露对专利性具有重要作用的信息，如 37 CFR 1.56 所定义，包括部分继续申请案的信息，及在之前申请案的备案日期与部分继续申请
案的国家或 PCT 国际备案日期之间可用的信息。
I acknowledge the duty to disclose information which is material to patentability as defined in 37 CFR 1.56, including for continuation-in-part
applications, material information which became available between the filing date of the prior application and the national or PCT international filing
date of the continuation-in-part application.

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[Page 1 of 4]
This collection of information is required by 35 U.S.C. 115 and 37 CFR 1.63. The information is required to obtain or retain a benefit by the public which is to file (and by the
USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 21 minutes to complete,
including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount
of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S.
Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Commissioner
for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTO/SB/101 (07-09)
Approved for use through 09/30/2010. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.

声明 — 实用专利或设计专利申请
DECLARATION — Utility or Design Patent Application
参与办公室允许查阅专利申请的授权书
Authorization To Permit Access To Application by Participating Offices



如果勾选此方框，下文签署者兹此授予 USPTO 权力，向欧洲专利局 (EPO)、日本专利局 (JPO)、韩国知识产权局 (KIPO)、世界知识产权办公室

(WIPO)及任何其它知识产权办公室（对上述专利申请主张拥有优先权的外国申请所备案之处）查阅上述专利申请。请参见 37 CFR 1.14(c) 和 (h)。如果
申请人不希望 EPO、JPO、KIPO、WIPO 或其它知识产权办公室（对上述专利申请主张拥有优先权的外国申请所备案之处）查阅上述专利申请，则不
要勾选此方框。
If checked, the undersigned hereby grants the USPTO authority to provide the European Patent Office (EPO), the Japan Patent Office (JPO), the
Korean Intellectual Property Office (KIPO), the World Intellectual Property Office (WIPO), and any other intellectual property offices in which a foreign
application claiming priority to the above-identified patent application is filed access to the above-identified patent application. See 37 CFR 1.14(c) and
(h). This box should not be checked if the applicant does not wish the EPO, JPO, KIPO, WIPO or other intellectual property office in which a foreign
application claiming priority to the above-identified patent application is filed to have access to the above-identified patent application.
根据 37 CFR 1.14(h)(3) 的规定，对一份上述专利申请的查阅将涉及以下方面：1) 上述备案的专利申请；2) 任何外国申请（如果某个满足 37 CFR 1.55
核准副本要求的外国申请已经在上述专利申请中备案，上述专利申请根据 35 U.S.C. 119(a)-(d) 对其主张优先权）；及 3) 在上述专利申请中要求利益的
任何美国备案申请。
In accordance with 37 CFR 1.14(h)(3), access will be provided to a copy of the above-identified patent application with respect to: 1) the aboveidentified patent application-as-filed; 2) any foreign application to which the above-identified patent application claims priority under 35 U.S.C. 119(a)(d) if a copy of the foreign application that satisfies the certified copy requirement of 37 CFR 1.55 has been filed in the above-identified patent
application; and 3) any U.S. application-as-filed from which benefit is sought in the above-identified patent application.
根据 37 CFR 1.14(c) 的规定，可以查阅关于参与办公室允许查阅申请的授权书的备案日期。
In accordance with 37 CFR 1.14(c), access may be provided to information concerning the date of filing the Authorization to Permit Access to
Application by Participating Offices.

外国优先利益主张
Claim of Foreign Priority Benefits
本人兹此根据 35 U.S.C. 119(a)-(d) 或 (f)，或 365(b) 的规定，对任何外国专利申请、发明人或植物育种者的权利证书主张外国优先利
益，或根据 365(a) 的规定对指定除了美国以外至少一个国家的任何 PCT 国际申请主张外国优先利益，如下所列并已确认，通过勾选方
框，对任何外国专利申请、发明人或植物育种者的权利证书，或在对本申请主张优先权之日之前备案的任何 PCT 国际申请主张外国优
先利益。
I hereby claim foreign priority benefits under 35 U.S.C. 119(a)-(d) or (f), or 365(b) of any foreign application(s) for patent, inventor’s or
plant breeder’s rights certificate(s), or 365(a) of any PCT international application which designated at least one country other than the
United States of America, listed below and have also identified below, by checking the box, any foreign application for patent,
inventor’s or plant breeder’s rights certificate(s), or any PCT international application having a filing date before that of the application
on which priority is claimed.
外国备案日期
之前的外国申请号码
Prior Foreign Application
Number(s)

国家
Country

(月/日/年)
Foreign Filing Date
(MM/DD/YYYY)

未主张的优先权
Priority
Not Claimed

是否附上核准副本？
Certified Copy Attached?
是
YES

本文所附的补充优先数据表 PTO/SB/02B 上列出了附加的外国申请号码。
Additional foreign application numbers are listed on a supplemental priority data sheet PTO/SB/02B attached hereto.
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[Page 2 of 4]

否
NO

PTO/SB/101 (07-09)
Approved for use through 09/30/2010. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.

声明 — 实用专利或设计专利申请
DECLARATION — Utility or Design Patent Application
所有信函寄住：
Direct all
correspondence to:

与客户编号相关的地
OR

址：
The address
associated with
Customer Number:

以下的信函地址
Correspondence address
below

或者

姓名
Name
地址
Address
城市
City
国家
Country

州
State
电话
Telephone

邮编
Zip
电子邮件
Email

警告：
WARNING:
呈请人/申请人应小心避免在专利申请中备案的文件中提交个人信息，这有可能会造成身份盗窃。USPTO 从不要求为支持呈请或申请而
提供社保号码、银行账号或信用卡号码等个人信息（除非是用于付款目的的支票或信用卡授权表 PTO-2038）。如果在提交给 USPTO
的文件中有此类个人信息，呈请人/申请人应当考虑在向 USPTO 提交文件之前编辑此类个人信息。兹告知呈请人/申请人，在公布申请
（除非根据 37 CFR 1.213(a) 的规定在申请中提出不予公布的请求）或签发专利之后，专利申请记录将公之于众。而且，如果在公布的申
请或签发的专利中引用了该申请，那么已弃用的申请记录也会公之于众(见 37 CFR 1.14)。为付款目的而提交的支票和信用卡授权表
PTO-2038 不会保留在申请文件中，因此不会向公众公布。兹告知呈请人/申请人，构成专利申请记录（例如 PTO/SB/01）的文件会放入
隐私法案记录系统 — 商务部 COMMERCE-PAT-7 中，系统名称：专利申请文件 (Patent Application Files)。不在申请文件中保留的文件
（例如 PTO-2038）则会放入隐私法案 COMMERCE/PAT-TM-10 系统中，系统名称：存款账户和电子资金转帐档案 (Deposit Accounts and
Electronic Funds Transfer Profiles)。
Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may contribute
to identity theft. Personal information such as social security numbers, bank account numbers, or credit card numbers (other than a
check or credit card authorization form PTO-2038 submitted for payment purposes) is never required by the USPTO to support a
petition or an application. If this type of personal information is included in documents submitted to the USPTO, petitioners/applicants
should consider redacting such personal information from the documents before submitting them to the USPTO. Petitioner/applicant is
advised that the record of a patent application is available to the public after publication of the application (unless a non-publication
request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of a patent. Furthermore, the record from an
abandoned application may also be available to the public if the application is referenced in a published application or an issued patent
(see 37 CFR 1.14). Checks and credit card authorization forms PTO-2038 submitted for payment purposes are not retained in the
application file and therefore are not publicly available. Petitioner/applicant is advised that documents which form the record of a patent
application (such as the PTO/SB/01) are placed into the Privacy Act system of records DEPARTMENT OF COMMERCE,
COMMERCE-PAT-7, System name: Patent Application Files. Documents not retained in an application file (such as the PTO-2038) are
placed into the Privacy Act system of COMMERCE/PAT-TM-10, System name: Deposit Accounts and Electronic Funds Transfer
Profiles.

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[Page 3 of 4]

PTO/SB/101 (07-09)
Approved for use through 09/30/2010. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.

声明 — 实用专利或设计专利申请
DECLARATION — Utility or Design Patent Application
本人兹此声明，就我所知本文所做的所有声明都是真实的，关于信息和观点的声明也是真实的；而且作出这些声明的前提是本人知道根
据 18 U.S.C. 1001 的规定，故意作出虚假声明及类似情况会受到罚款或监禁等惩罚，而此种故意作出的虚假声明可能会危及本申请或任
何已签发专利的有效性。
I hereby declare that all statements made herein of my own knowledge are true and that all statements made on information and
belief are believed to be true; and further that these statements were made with the knowledge that willful false statements and the
like so made are punishable by fine or imprisonment, or both, under 18 U.S.C. 1001 and that such willful false statements may
jeopardize the validity of the application or any patent issued thereon.
唯一或第一发明人的姓名：
NAME OF SOLE OR FIRST INVENTOR:

已为此未签名发明人备案了一份呈请书
A petition has been filed for this unsigned inventor

名字（首名字和中间名[如有的话]）
Given Name (first and middle [if any])

姓氏
Family Name or Surname

发明人签名
Inventor's Signature
住址：城市
Residence: City

日期
Date
州
State

国家
Country

公民身份
Citizenship

州
State

邮编
Zip

国家
Country

邮寄地址
Mailing address
城市
City

本文所附的_________补充表 PTO/SB/02A 或 02LR 中指明了其他发明人或法定代表。
Additional inventors or a legal representative are being named on the ___________supplemental sheet(s) PTO/SB/02A or 02LR attached hereto.

[第 4 页，共 4 页]
[Page 4 of 4]

隐私法案声明
1974 年隐私法案 (P.L. 93-579) 规定，应向您提供某些信息，这些信息涉及您提交与专利申请或专利相关的附属
表格。因此根据本法案的要求，兹告知：(1) 根据 35 U.S.C. 2(b)(2) 的一般授权收集这些信息；(2) 自愿提供所请
求的信息；及 (3) 美国专利与商标局使用这些信息的主要目的是处理及/或审查与专利申请或专利相关的提交材料。
如果您不提供所需的信息，美国专利与商标局可能无法处理及/或审查您的提交材料，从而导致申请程序终止或
放弃申请或专利到期。
您在本表格中提供的信息将进行以下的常规使用：
1.

本表格中的信息将根据信息自由法案
(5 U.S.C. 552) 及隐私法案 (5 U.S.C. 552a) 的规定进行保密处理。本
记录系统中的记录可能会披露给司法部，以确定信息自由法案是否要求披露这些记录。

2.

在常规使用中，如在向法庭、地方法官或行政法庭呈交证据时，可能会披露本记录系统中的某条记录，
包括在和解协商过程中，向对方律师披露。

3.

在常规使用中，如果某位国会议员提出涉及本记录系统中某位与记录有关的个人的请求，而这个人曾经
就该条记录的主题向该国会议员请求帮助，那么这条记录可能向该国会议员披露。

4.

在常规使用中，如果本机构的某位承包商为履行合约而需要获得信息时，那么本记录系统中的某条记录
可能会向该承包商披露。信息接收者应遵守 1974 年隐私法案（已根据 5 U.S.C. 552a(m) 的规定进行了修
订）的要求。

5.

在常规使用中，根据专利合作条约的规定，本记录系统中根据专利合作条约备案的某份国际申请的记录
可能会向世界知识产权组织国际局披露。

6. 在常规使用中，出于国家安全审查 (35 U.S.C. 181) 和根据原子能法案 (42 U.S.C. 218(c)) 进行审查的目的，
本记录系统中的某条记录可能会向另一个联邦机构披露。
7.

在常规使用中，当总务管理局
(GSA) 根据 44 U.S.C. 2904 和 2906 的授权，作为其履行对记录管理实践
和程序推荐改善建议的责任的一部分，在对记录进行检查的过程中，本记录系统的某条记录可能会向总
务管理局的局长或其指定人员披露。此种披露应根据为此目的的 GSA 记录检查规定及任何其他相关指
令（如 GSA 或商务部）来进行。此种披露不得用于对个人做出判定。

8.

在常规使用中，根据
35 U.S.C. 122(b) 公布专利申请之后或根据 35 U.S.C. 151 的规定签发专利之后，可
能向公众披露本记录系统中的某条记录。而且在常规使用中，如果在某项申请中备案的记录被遗弃，或
申请流程被终止，而且某份已公布的申请、某份供公众检查的申请或已签发的专利引用了该申请，那么
可能会向公众披露某条记录，但受到 37 CFR 1.14 的限制。

9.

在常规使用中，如果
USPTO 意识到会违反或可能违反法律或规定，则可能会向联邦、州或当地执法部
门披露本记录系统中的某条记录。

Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your submission
of the attached form related to a patent application or patent. Accordingly, pursuant to the requirements of the Act, please
be advised that: (1) the general authority for the collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the
information solicited is voluntary; and (3) the principal purpose for which the information is used by the U.S. Patent and
Trademark Office is to process and/or examine your submission related to a patent application or patent. If you do not
furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your
submission, which may result in termination of proceedings or abandonment of the application or expiration of the patent.
The information provided by you in this form will be subject to the following routine uses:
1. The information on this form will be treated confidentially to the extent allowed under the Freedom of Information
Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records may be disclosed to the
Department of Justice to determine whether disclosure of these records is required by the Freedom of Information Act.
2. A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a
court, magistrate, or administrative tribunal, including disclosures to opposing counsel in the course of settlement
negotiations.
3. A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a request
involving an individual, to whom the record pertains, when the individual has requested assistance from the Member
with respect to the subject matter of the record.
4. A record in this system of records may be disclosed, as a routine use, to a contractor of the agency having need for the
information in order to perform a contract. Recipients of information shall be required to comply with the
requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S.C. 552a(m).
5. A record related to an International Application filed under the Patent Cooperation Treaty in this system of records
may be disclosed, as a routine use, to the International Bureau of the World Intellectual Property Organization,
pursuant to the Patent Cooperation Treaty.
6. A record in this system of records may be disclosed, as a routine use, to another federal agency for purposes of
National Security review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Act (42 U.S.C. 218(c)).
7. A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services, or
his/her designee, during an inspection of records conducted by GSA as part of that agency's responsibility to
recommend improvements in records management practices and programs, under authority of 44 U.S.C. 2904 and
2906. Such disclosure shall be made in accordance with the GSA regulations governing inspection of records for this
purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make
determinations about individuals.
8. A record from this system of records may be disclosed, as a routine use, to the public after either publication of the
application pursuant to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C. 151. Further, a record may be
disclosed, subject to the limitations of 37CFR 1.14, as a routine use, to the public if the record was filed in an
application which became abandoned or in which the proceedings were terminated and which application is
referenced by either a published application, an application open to public inspection or an issued patent.
9.

A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law enforcement
agency, if the USPTO becomes aware of a violation or potential violation of law or regulation.