PTO/SB/AIA/01 37 CFR 1.76 and 37 CFR 1.63 Declaration (37 CFR 1.63) fo

Initial Patent Applications

aia0001cn

Original New Utility Applications

OMB: 0651-0032

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PTO/AIA/01 (06-12)
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使用申请信信息
息表 (37 CFR 1.76) 申请实用专利或设计专利的声明 (37 CFR 1.63)


DECLARATION (37 CFR 1.63) FOR UTILITY OR DESIGN APPLICATION USING AN APPLICATION

DATA SHEET (37 CFR 1.76)


发明名
发明
名称

Title of Invention

作为下方署名的发明人,本人兹此声明:

As the below named inventor, I hereby declare that:

本声明指:

This declaration is
directed to:

或
D T随he附a的tta申ch请ed, application,
or
D 美国申请号码或 PCT 国际申请号码____________________ 备案于____________________。

United States application or PCT international application number ____________________ filed on ____________________.

上述申请由本人提交或授权提交。

The above-identified application was made or authorized to be made by me.

本人相信,本人是该申请中所主张发明的原发明人或原联合发明人。

I believe that I am the original inventor or an original joint inventor of a claimed invention in the application.

本人兹此承认,此声明中若有任何故意的虚假陈述,本人将根据

的规定被处以罚款或五 年以下有期徒刑,或者两罚并施。

18 U.S.C. 1001
(5)
I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001 by fine or imprisonment of not more
than five (5) years, or both.

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。
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.

发明人依法登记的姓名

LEGAL NAME OF INVENTOR

发明人:

__________________________________________________________________
Inventor: __________________________________________________________________

日期(选填): __________________________

Date (Optional): __________________________

签名:
注意:此表格必须随附包含整个发明实体命名的申请信息表(PTO/AIA/14 或同等信息表),或者此信息表必须先前已被提交。其他每名发明人均需使用一
份 PTO/AIA/01 信息表。

__________________________________________________________________________________________________________
Signature: __________________________________________________________________________________________________________

Note: An application data sheet (PTO/AIA/14 or equivalent), including naming the entire inventive entity, must accompany this form or must have been
previously filed. Use an additional PTO/AIA/01 form for each additional inventor.

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 1 minute 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.

隐私法案声明

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) 授予收集这些信息的一般授权;(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了一项请求并且该请求涉及与本记录系统中的记录有关的个人,
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,为履行其对记录管理实践和
程序提出改善建议之部分责任,在对记录进行检查的过程中,本记录系统中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。此种披露应根据与此目的相关的 GSA 记录检查规定及任何其他相关(如
GSA 或商务部)指令来进行。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弃用,
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。

1974


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