PTO/SB/102 Declaration and Power of Attorney for Patent Application

PTO/SB/102 (6-95)
Approved for use through X/XX/XX OMB 0651-0032
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 displays a valid OMB control number.

Declaration and Power of Attorney for Patent Application
VERKLARING EN VOLMACHT VOOR OCTROOIAANVRAAG
Dutch Language Declaration
As a below named inventor, I hereby declare that:
Als een hieronder vermelde uitvinder, verklaar ik hierbij dat:
My residence, post office address and citizenship are as stated next to
my name.

mijn woonplaats, Postadres en nationaliteit hieronder correct naast mijn
naam zijn vermeld en dat

I believe I am the original, first and sole inventor (if only one name is listed
below) or an original, first and joint inventor (if plural names are listed
below) of the subject matter which is claimed and for which a patent is
sought on the invention entitled

ik geloof de oorspronkelijke, eerste en enige uitvinder te zijn (indien
hieronder slechts één naam is vermeld), of een oorspronkelijke en eerste
mede-uitvinder te zijn (indien hieronder meer dan een naam is vermeld),
van de materie waarop aanspraak wordt gemaakt en waarvoor een
octrooi wordt aagnevraagd betreffende de uitvinding getiteld:

_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

the specification of which is attached hereto unless the following box is
checked:

waarvan de beschrijving bij deze is bijgesloten, tenzij het onderstaande
vak is aangekruist:

M
M

werd ingediend op ______________________
onder het Amerikaanse aanvraagnummer
International
Aanvraagnummer
______________ en werd herzien op
_________________ (indien van toepassing).

of

PCT

was filed on ________________________
as United States Application Number or PCT International
Application Number
______________ and was amended on
______________ (if applicable).

I hereby state that I have reviewed and understand the contents of the
above identified specification, including the claims, as amended by any
amendment referred to above.

Ik verklaar hierbij dat ik de inhoud van de hierboven vermelde beschrijving
heb bestudeerd en begrijp, met inbegrip van de aanspraken zoals herzien
in de hierboven aangegeven wijziging.

I acknowledge the duty to disclose information which is material to
patentability as defined in Title 37, Code of Federal Regulations, § 1.56.

Ik erken mijn verplichting om informatie te verstrekken die betrekking
heeft op de beoordeling van deze aanvraag volgens Titel 37, Wetboek
van Federale Overheidsvoorschriften, § 1.56.

Page 1 of 4
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PTO/SB/102 (6-95)
Approved for use through X/XX/XX OMB 0651-0032
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 displays a valid OMB control number.

Dutch Language Declaration
Ik maak hierbij aanspraak op het recht tot buitenlandse voorrang
onder Titel 35 van het Wetboek van de Verenigde Staten § 119
(a)-(d) of § 365(b), voor de buitenlandse patentaanvra(a)g(en) of
uitvindingscertificaten, of § 365(a) voor de PCT internationale
aanvra(a)g(en) waarop tenminste één ander land dan de
Verenigde Staten is aangegeven, die hieronder zijn vermeld, en ik
heb eveneens hieronder door het aankruisen van het vakje
aangegeven van welke buitenlandse patent- of
uitvindingscertificaat-aanvra(a)g(en) of PCT internationale
aanvra(a)g(en) de datum van aanvraag valt vóór de datum van de
aanvraag waarvoor aanspraak op voorrang gemaakt wordt.
____________________
(Number)
(Nummer)

_______________________
(Country)
(Land)

____________________
(Number)
(Nummer)

_______________________
(Country)
(Land)

____________________
(Number)
(Nummer)

_______________________
(Country)
(Land)

application which designated at least one country other than the
United States, listed below and have also identified below, by
checking the box, any foreign application for patent or inventor’s
certificate, or PCT International application having a filing date
before that of the application on which priority is claimed.

Priority Not Claimed
________________________________
(Day/Month/Year Filed)
(Dag/Maand/Jaar van indiening)

M

________________________________
(Day/Month/Year Filed)
(Dag/Maand/Jaar van indiening)

M

________________________________
(Day/Month/Year Filed)
(Dag/Maand/Jaar van indiening)

M

I hereby claim the benefit under Title 35, United States Code,
§ 119(e) of any United States provisional application(s) listed
below.

Ik maak hierbij aanspraak op het voorrecht onder Titel 35 van het
Wetboek van de Verenigde Staten, § 119(e), voor hieronder
vermelde voorlopige Amerikaanse aanvra(a)g(en).

____________________
(Application No.)

_______________________
(Filing Date)

____________________
(Aanvraagnummer)

_______________________
(Datum van indiening)

____________________
(Application No.)

_______________________
(Filing Date)

____________________
(Aanvraagnummer)

_______________________
(Datum van indiening)

I hereby claim the benefit under Title 35, United States Code,
§ 120 of any United States application(s), or § 365(c) of any PCT
International application designating the United States, listed
below and, insofar as the subject matter of each of the claims of
this application is not disclosed in the prior United States or PCT
International application in the manner provided by the first
paragraph of Title 35, United States Code, § 112, I acknowledge
the duty to disclose information which is material to patentability
as defined in Title 37, Code of Federal Regulations, § 1.56 which
became available between the filing date of the prior application
and the national or PCT International filing date of this application.

Ik maak hierbij aanspraak op het voorrecht onder Titel 35 van het
Wetboek van de Verenigde Staten, § 120 van eventueel hieronder
vermelde Amerikaanse aanvra(a)g(en), of § 365(c) van eventueel
hieronder vermelde PCT internationale aanvra(a)g(en) waarop de
Verenigde Staten zijn aangegeven, en ik erken de verplichting om
informatie die relevant is voor patentverlening, zoals gedefinieerd
in Titel 37, Wetboek van Federale Overheidsvoorschriften, § 1.56,
te openbaren, en die beschikbaar is geworden tussen de
aanvraagdatum van de vorige aanvraag en de aanvraagdatum van
deze nationale of PCT Internationale aanvraag, voor zover de
materie van elke aanspraak van deze aanvraag niet is
geopenbaard in de voorafgaande Amerikaanse aanvraag volgens
de methode zoals beschreven in eerste paragraaf van Titel 35 van
het Wetboek van de Verenigde Staten, § 112.
____________________
(Application Serial No.)
(aanvraagnummer)

_______________________
(Filing Date)
(Datum van indiening)

____________________
(Application Serial No.)
(aanvraagnummer)

_______________________
(Filing Date)
(Datum van indiening)

___________________________________________________
(Status)
(Status)
(patented, pending, abandoned)

____________________________________________________
(Status)
(Status)
(patented, pending, abandoned)

I hereby claim foreign priority under Title 35, United States Code,
§ 119(a)-(d) or § 365(b) of any foreign application(s) for patent or
inventor’s certificate, or § 365(a) of any PCT International

[page 2 of 4]

PTO/SB/102 (6-95)
Approved for use through X/XX/XX OMB 0651-0032
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 displays a valid OMB control number.

hierbij verklaar ik dat alle in dit document op basis van mijn kennis afgelegde
verklaringen waar zijn en dat alle verklaringen gemaakt op basis van informatie en
overtuiging naar mijn beste weten waar zijn en verder verklaar ik dat deze
verklaringen werden afgelegd in de kennis dat opzettelijk valse verklaringen en
dergelijke, die zodanig gemaakt zijn, strafbaar zijn met boetes ofgevangenisstraf, or
beide, volgens Hoofddeel 1001 van Titel 18 van het Wetboek van de Verenigde
Staten en dat dergelijke opzettelijk valse verklaringen de geldigheid van de aanvraag
of een daaruit resulterend octrooi in gevaar kunnen brengen.
Dutch Language Declaration
VOLMACHT: Als met naam genoemde uitvinder, benoem ik hierbij de volgende
advoka(a)t(en) en/of vertegenwoordiger(s) om deze aanvraag te behandelen en om
alle daarmee samenhangende zaken te verrichten bij het Bureau voor Octrooien en
Handelsmerken (geef naam en registratienummer):

PTO/SB/102 (6-95)
Approved for use through X/XX/XX OMB 0651-0032
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 displays a valid OMB control number.

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 Section 1001 of Title 18 of the
United States Code and that such willful false statements may
jeopardize the validity of the application of any patent issued
thereon.

POWER OF ATTORNEY: As a named inventor, I hereby appoint
the following attorney(s) and/or agent(s) to prosecute this
application and transact all business in the Patent and Trademark
Office connected therewith. (list name and registration number).

Gelieve alle
correspondentie te addresseren aan:

Gelieve alle telefoongesprekken te richten tot:
(naam en telefoonnummer)

Send Correspondence to:

Direct Telephone Calls to: (name and telephone number)

[page 3 of 4]

Dutch Language Declaration

PTO/SB/102 (6-95)
Approved for use through X/XX/XX OMB 0651-0032
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 displays a valid OMB control number.

Volledige naam van enige of eerste uitvinder

Handtekening van uitvinder

Full name of sole or first inventor

Datum

Inventor’s signature

Woonplaats

Residence

Nationaliteit

Citizenship

Postadres

Post Office Address

Volledige naam van tweede mede-uitvinder, indien van toepassing

Full name of second joint inventor, if any

Handtekening van tweede uitvinder

Second Inventor’s signature

Datum

Date

Date

Woonplaats

Residence

Nationaliteit

Citizenship

Postadres

Post Office Address

(Geef dezelfde informatie en handtekening voor een derde en volgende
mede-uitvinders.)

(Supply similar information and signature for third and subsequent
joint inventors.)

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