PTO/SB/101 Declaration for Utility or Design Patent Application (37

Doc code: Oath
Document Description: Oath or declaration filed

PTO/SB/101 (05-16)
Approved for use through 11/30/2020. 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.

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



初次
备案后提交的
声明（需要
支付附加费（37 CFR
1.16(f)）
Declaration
Submitted After Initial
Filing (surcharge
(37 CFR 1.16(f))
required)

代理人案号
Attorney Docket Number
第一发明人姓名
First Named Inventor
如有，请填写
COMPLETE IF KNOWN
申请号码
Application Number
申请日期
Filing Date
技术单位
Art Unit
审查员姓名
Examiner Name

本人兹此声明：(1) 每位发明人的居住地、邮寄地址和公民身份即是下文他们姓名旁边所列之信息；并且 (2) 本人相信下列发明人为本主题发明的最初和第一
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)
该发明的申请由本人提交或授权提交，并
the application of which was made or was authorized to be made by me and



在此随附
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）
____________________修订（如适用）。
was filed on (MM/DD/YYYY) ____________________ as United States Application Number or PCT International Application Number
____________________ and was amended on (MM/DD/YYYY) ____________________ (if applicable).

本人兹此声明本人已审阅并理解理解根据上文参考的任何修订文件进行修订的上述申请内容，包括权利主张。
I hereby state that I have reviewed and understand the contents of the above identified application, 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 Administrative 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 (05-16)
Approved for use through 11/30/2020. 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
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.
此前的外国申请号码
Prior Foreign Application
Number(s)

国家/地区
Country

外国申请备案日期（月/日/年）
Foreign Filing Date
(MM/DD/YYYY)

未主张的优先权
Priority Not Claimed







是否已附上核准副本
Certified Copy Attached?
是
否
YES
NO






本文所附的补充优先权数据表 PTO/SB/02B 列出了其他的外国申请号码。
Additional foreign application number(s) are listed on a supplemental priority data sheet PTO/SB/02B attached hereto.
[第 2 页，共 4 页]
[Page 2 of 4]

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PTO/SB/101 (05-16)
Approved for use through 11/30/2020. 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
寄往：
Direct all
Correspondence to:



与客户
编号相关的
地址：
The address
Associated with
Customer Number:

或者
OR



以下的
信函地址
Correspondence
address below

姓名
Name
地址
Address
城市
City
国家/地区
Country

州/省
State

邮政编码
Zip

电话
Telephone

电子邮箱
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。
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与任何已签发专利的有效性。
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 18 U.S.C. 1001 的规定被处以罚款或五 (5) 年以下有期徒刑，或者两罚并施。
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.
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.
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.
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[Page 3 of 4]

PTO/SB/101 (05-16)
Approved for use through 11/30/2020. 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

唯一或第一发明人的姓名
NAME OF SOLE OR FIRST INVENTOR:
名字（首名字或中间名[如有]）
Given Name (first and middle [if any])



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

姓氏
Family Name or Surname

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

日期
Date
州/省
State

国家/地区
Country

公民身份
Citizenship

州/省
State

邮政编码
Zip

国家/地区
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

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[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) 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
2.
3.

4.
5.
6.

7.

8.

9.

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。
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。
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。
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。
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。
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。
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。
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。
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。

OMB Clearance and PRA Burden Statement for PTO/SB/101
This collection of information is required by 37 CFR 1.137. 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, 1.14 and 41.6. This form is estimated to
take 21 minutes to complete, including gathering, preparing, and submitting the completed 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 Administration 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: Mail Stop Petition, Commissioner for Patents, P.O. Box 1450, Alexandria, VA
22313-1450.

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. The United States Patent and Trademark Office (USPTO) collects this information under authority of 5 CFR 339.205.
The information in this system of records is used to manage all records of applicant including name, citizenship, residence, post office address and
other information pertaining to the applicant's activities in connection with the invention for which a patent is sought. Statements containing various
kinds of information with respect to inventors who are deceased or incapacitated, or who are unavailable or unwilling to make application for patent.
The information obtain is protected from disclosure to third parties in accordance with the Privacy Act.
However, routine uses of this information may include disclosure to the following: to law enforcement and investigation in the event that the system
of records indicates a violation or potential violation of law; to a Federal, state, local, or international agency, in response to its request; to an agency,
organization, or individual for the purpose of performing audit or oversight operations as authorized by law; to non-federal personnel under contract
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Failure to provide any part of the requested information may result in an inability to process requests for access and information. The applicable
Privacy Act System of Records Notice for this information is COMMERCE/PAT-TM-7 Patent Application Files, available at Federal Register /Vol. 78, No.
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