二一一国家技术发明奖申请书.docx

1、二一一国家技术发明奖申请书二一一年度國家技術發明獎申請書Application Form for2011 State Technological Invention AwardI. 項目基本情況General Description of the Project1. 項目名稱Project Title2. 主要完成人Principal Persons Who Complete the Project(主要完成人的姓名應按貢獻大小從左至右順序列出Names of principal persons should be listed according to their contributions

2、 to the project)3. 項目名稱可否公布Can the Projects Title be Disclosed 可Yes 否 No保密期限Duration of Confidentiality（年/Year）4. 所屬國民經濟行業The National Economy Industry Sector that the Project Belongs to (請參照本申請書填寫說明的項目基本情況Please see “General Description of the Project” of the Notes on How to Complete the Applicatio

3、n Form for classification) A B C D E F G H I J K L M N O P Q R S T5. 任務來源Source of Task A. 國家計劃State Programs (A1. 國家科技攻關計劃 States Key Technologies R&D Program A2. 863計劃 Program A3. 973計劃 Program A4. 其他 Others) B. 部委計劃 Programs of Ministries or Commissions C. 省、市、自治區計劃 Programs of Provinces, Municip

4、alities, or Autonomous Regions D. 基金資助 Foundation (D1. 國家自然科學基金 National Natural Science Foundation D2. 其他基金 Others) E. 企業 Enterprises F. 國際合作 International Cooperation G. 非職務 Not Within Ones Own Job Responsibilities H. 自選 Self-Chosen I. 其他 Others6. 項目起止時間Project Commencement and Completion Dates起始於

5、Started from(日/月/年DD/MM/YY)完成於Completed by(日/月/年DD/MM/YY)II. 項目簡介Brief Introduction of the Project主要技術內容、授權專利情況、技術經濟指標、應用及效益情況Major technological content, grant of patents and licensing condition, techno-economic indicator, as well as application and effectiveness（中文不超過1200字; not exceed 600 words in

6、 English）III. 主要技術發明Major Technological Inventions（中文不超過5頁; not exceed 3 pages in English）IV. 第三方評價和應用情況Third Party Assessment and Application of the Project1. 第三方評價Third Party Assessment of the Project2. 應用情況Application（中文不超過2頁; not exceed 1 page in English）3. 經濟效益（社會公益類、國家安全類項目可以不填此欄） Economic Ben

7、efits (This part may not be required for public welfare and national security projects)單位:萬元(港幣)Unit: in Ten Thousand (HKD)項目總投資額Total Investment Amount of the Project回收期(年) Yield (Years)年份Year新增利潤Newly Created Profits新增稅收Newly Created Tax創收外匯(港幣)Foreign Exchange Earned (HKD)節支總額Total Expenses being

8、 Cut Down累計 Total各欄目的計算依據 The Basis of Calculation for Each Item（中文不超過200字; not exceed 100 words in English）4. 社會效益Social Benefits（中文不超過200字; not exceed 100 words in English）5. 主要應用單位目錄List of Major Organizations Applying the Project應用單位名稱Organizations應用技術Technology being Applied應用起止時間(由年/月至年/月)Time

9、 of Application of the Project(From mm/yy to mm/yy)應用單位聯絡人及電話Name and Phone No. of Contact Person of the Applying Organisation使用本發明產生的經濟效益 (萬港元)Economic Benefits Achieved by Applying the Project(Ten Thousand HKD)V. 本項目曾獲科技獎勵情況Information on Science and Technology Awards Given to This Project獲獎項目名稱Na

10、me of Awarded Projects獲獎時間Dates ofAward Presentation獎項名稱Name of Awards獎勵等級Grades of Awards授獎部門 (單位)Departments (Units) which Conferred AwardsVI. 知識產權證明目錄Proof of Intellectual Property Rights (IPR)授權項目名稱Project Title知識產權類別Categories of IPR國（區）別Country / Region申請號Application No.授權號Patent No.VII. 技術評價證

11、明及國家法律法規要求行業審批文件目錄Proof of Technological Assessment and Approving Documents on the Industries Required by the States Laws and RegulationsVIII. 主要完成人情況*Information on Principal Person Who Completes the Project*姓名Name性別 M / FGender出生日期Date of Birth (mm/yy)出生地 （省/市）Place of Birth (Municipality/ Provinc

12、e)民族Ethnic Group身份證號碼ID Card No國籍Nationality行政職務Occupation工作單位Unit in which Principal Person Works完成單位Unit in which the Project Completed通訊地址Correspondence Address聯絡電話Contact Phone No.住宅電話Phone No. (Home)手提電話Mobile No.電子信箱E-mail Address畢業學校School Graduated畢業時間Date of Graduation文化程度Education Level技術職

13、稱Technical Title專業、專長Professional Field or Specialty最高學位Academic Degree曾獲科技獎勵情況Technology Awards Received 參加本項目起止時間Commencement and Completion Date of Project Participation自From 至To (mm/yy)對本項目技術創造性貢獻Contributions to the Major Technological Content of the Project（中文不超過300字; not exceed 150 words in E

14、nglish）本人簽名Signature of Principal Person日期Date* 請由第一頁所填寫的主要完成人填寫，如由多於一人完成項目，則所有完成人均須填寫這份資料。如有需要可影印此頁。 This refers to “Principal Persons Who Complete the Project” on page 1. If more than one person complete the project, each of the persons involved has to fill in a form. This page can be photocopied

15、if necessary.IX. 附件目錄Table of Contents of Appendices1. 知識產權證明Proof of Intellectual Property Rights2. 應用證明Proof of applications3. 技術評價證明及國家法律法規要求行業審批文件Proof of technological assessment and approving documents on the industries required by the States laws and regulations 4. 其他證明Other proving documents

16、5. 所有完成人的有效身份証明文件（如香港身份証、中國護照等）Copy of the identity documents of all applicants (e.g. Hong Kong Identity Card, PRC Passport, etc.)註：Note(1) 附件要求請參閱申請書填寫說明第IX部分，並提供目錄，順序排列及標記附件，以方便核對。For submission requirements on the appendices, please refer to Part IX of the “Notes on How to Complete the Applicatio

17、n Form”. The appendices should be labeled according to the order of the content page.(2) 申請人提供的所有資料，本署將會嚴格保密及只會用作處理國家技術發明獎申請。然而，為了處理申請或按照法律規定，本署或會將該等資料向有關的其他政府部門或第三者透露。申請人提交申請，即表示已明確同意披露該等資料。申請人可致電2737 2250或傳真2375 0715，要求查閱或更正其個人資料。All information provided by the applicant will be kept in confidence

18、 and only used for the purpose of processing the 2011 STIA application. It may however be disclosed to other related Government departments or third parties, if such disclosure is necessary for the purposes of processing the application or required by law. The submission of the application denotes t

19、hat the applicant has given explicit consent to such disclosure. Applicant can request access to or correction of personal data provided in the application by contacting us at 2737 2250 or fax at 2375 0715.X. 呈交申請書Submission of Application申請書主件必須以中文及英文分別填寫。請把已填妥的申請書主件的軟複本（word format）連同一式四份的申請書主件及附件

20、（活頁釘裝）親身或以專人派遞交到下列地址：The main application form should be completed in both Chinese and English (in separate copy). Please send one softcopy of the main application form (in word format) and four hardcopies of the main application form and the appendices (in loose binding) to the following address in person or by courier:香港灣仔皇后大道東213號胡忠大廈20樓創新科技署Innovation and Technology Commission20/F Wu Chung House213 Queens Road EastWan Chai, Hong Kong電話Tel: 2737 2250傳真Fax: 2375 0715網址Website: www.itc.gov.hk/en/ssta www.itc.gov.hk/ch/ssta