Form WIPO D/1/I WIPO D/1/I Annex I: Oath or Declaration of the creator

DM/1/I (E)

ANNEX I
Oath or Declaration of the Creator under Rule 8(1)(a)(ii) of
the Common Regulations
IMPORTANT
1.

This Annex is mandatory content for an international application designating the United States of America.

2.

This Annex can be used to submit a Declaration of Inventorship (Declaration), following Rule 8(1)(a)(ii) OR, in
the impossibility to provide such declaration, a Substitute Statement in Lieu of a Declaration of Inventorship
(Substitute Statement). Please provide a Declaration OR a Substitute Statement for each creator indicated
under item 11 of the DM/1 form.

3.

The Declaration and Substitute Statement require the signer to declare inventorship with respect to a “claimed
invention”. For further information regarding a “claimed invention”, refer to the Hague Guide for Users,
International Application – Item 12.

4.

This Annex may also be used by applicants who wish to submit an alternative document that they know is
deemed a valid inventor’s oath or declaration under the United States of America national requirements.

5.

For detailed information on the inventor’s oath or declaration, visit the USPTO website:
https://www.uspto.gov/sites/default/files/forms/aia_oathdecl_guide.pdf.

6.

This Annex must be submitted with form DM/1 at the time of filing the international application together with
the Declaration/Substitute Statement/Alternative Document referred to above.

7.

Please number your pages.

For use by the applicant
This Annex concerns the international application referenced by the applicant as below:
Reference:
For use by WIPO
Document type: DDO
Contracting Party: US
Declaration Under Rule 8(1)(a)(ii) of the Common Regulations
Number of pages (including this cover page):
August 2023

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ANNEX I – DECLARATION OF INVENTORSHIP (page 1 of 1)
Declaration of Inventorship for the Designation of the United States of America
I hereby declare that I believe I am the original inventor or an original joint inventor of a claimed
invention in the application.
This declaration is directed to the attached international application (if filing declaration with
application).
This declaration is directed to international
application:
(if furnishing declaration after filing the application, the declaration must identify the international
application by the application reference number assigned by the International Bureau or the
office of indirect filing, or by applicant’s reference number which was on the application as filed).
I hereby declare that the above-identified international application was made or authorized to be
made by me.
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.
Legal Name of Inventor:
Family (last) name, given (first) name

Inventor’s Signature:
The signature must be that of the inventor, not that of the agent.

Date (optional):
Residence:
City:
U.S. State
(if applicable):
Country:

(required only if the inventor lives at a location different from the
mailing address contained in the international application)

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ANNEX I – SUBSTITUTE STATEMENT (page 1 of 2)
Substitute Statement in Lieu of a Declaration of Inventorship for the Designation of the
United States of America
This statement is directed to:
the attached international application
or
international application:
(if furnishing statement after filing the application, the statement must identify the international
application by the application reference number assigned by the International Bureau or the
office of indirect filing, or by applicant’s reference number which was on the application as filed).
Legal name of inventor to whom this substitute statement applies:

Family (last) name, given (first) name

Residence:

(not required if the inventor lives at the same location as the mailing
address contained in the international application, or the inventor is
deceased or legally incapacitated)

City:
U.S. State
(if applicable):
Country:
I believe the above-named inventor or joint inventor to be the original inventor or an original joint
inventor of a claimed invention in the application.
The above-identified application was made or authorized to be made by me.
I hereby acknowledge that any willful false statement made in this statement is punishable
under 18 U.S.C. 1001 by fine or imprisonment of not more than five (5) years, or both.
Relationship to the inventor to whom this substitute statement applies:
Legal Representative (for deceased or legally incapacitated inventor only)
Assignee
Person to whom the inventor is under an obligation to assign
Person who otherwise shows a sufficient proprietary interest in the matter (a petition
under 37 CFR 1.46 is required and should be submitted directly to the USPTO after
publication of the international registration), or
Joint inventor

ANNEX I – SUBSTITUTE STATEMENT (page 2 of 2)

page 4

Circumstances permitting execution of this substitute statement:
Inventor is deceased
Inventor is under legal incapacity
Inventor cannot be found or reached after diligent effort, or
Inventor has refused to execute the oath or declaration under 37 CFR 1.63
Person executing this Substitute Statement
Name:
Date (optional):
Signature:
The party who is signing the substitute statement must be an applicant. If the applicant
is a juristic entity (legal entity), list the applicant name and the title of the signer below.
Applicant name:
Title of person
executing this
Substitute Statement:

The signer, whose title is supplied above, is authorized to act on behalf of the
applicant.

Residence of the signer: (not required if the signer’s mailing address is contained in the
international application or indicated below and the signer lives at the
same location as the mailing address)
City:
U.S. State
(if applicable):
Country:

Mailing address of the signer:
City:
U.S. State
(if applicable):
Zip:
Country:

(not required if contained in the international application)