二○一九年度國家科學技術進步獎申請書Application Form forthe 2019 State Scientific and Technological Progress AwardI.項目基本情況General Description of the Project1.項目名稱Project Title2.主要完成人Principal Person(s) who Completed the Project（主要完成人的姓名應按貢獻大小順序列出Names of principal persons should be listed in order of their contributions to the project）3.主要完成單位Principal Unit(s) at which the Project was Completed（主要完成單位應按貢獻大小順序列出Principal units should be listed in order of their contributions to the project）4. 所屬國民經濟行業The National Economy Industry Sector that the Project Belongs to（請參看本申請書填寫說明的第I部分Please refer to Part I of the Notes on How to Complete the Application 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□B. 部委計劃Programs of Ministries or Commissions□C. 省、市、自治區計劃Programs of Provinces, Municipalities, 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. 自選Self-Chosen□H. 其他Others6. 項目起止時間Project Commencement and Completion Dates起始於Started from （日/月/年dd/mm/yy）完成於Completed by （日/月/年dd/mm/yy）7.已授權的發明專利數目No. of Patent(s) Granted8.已授權的其他知識產權數目No. of Other Intellectual Property Rights GrantedII.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、推廣應用及效益情況Major technological content, grant of patents and licensing condition, techno-economic indicator, as well as promotion of application and effectiveness（中文不超過1200字; not exceed 600 words in English）III.主要科技創新Major Technological Innovations1.主要科技創新Major Technological Innovations（中文不超過5頁; not exceed 3 pages in English）2.科技局限性Technological Limitations（中文不超過1頁; not exceed 0.5 page in English）IV. 第三方評價Third Party Assessment of the Project（中文不超過2頁; not exceed 1 page in English）V.推廣應用情況、經濟效益和社會效益Promotion and Application, Economic Returns and Social Benefits 1.推廣應用情況Promotion and Application應用單位名稱Unit Applying the Project應用技術Technology Applied應用起止時間（由月/年至月/年）Period of Application(From mm/yy tomm/yy)應用單位聯絡人及電話Contact Person of theUnit (Name and Tel.)應用情況Description ofApplication2.近三年直接經濟效益Direct Economic Returns in the Past 3 Years主要經濟效益的有關說明Details of Major Economic Returns（中文不超過300字; not exceed 150 words in English）其他經濟效益的有關說明Other Economic Returns（中文不超過300字; not exceed 150 words in English）3. 社會效益Social Benefits（中文不超過600字; not exceed 300 words in English）VI.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Name of AwardedProject獲獎時間Date of Award獎項名稱Name of Award獎勵等級Class of Award主要獲獎人Name of MajorAwardees授獎單位Unit whichConferred AwardVII.知識產權證明目錄（按與主要技術發明的密切程度排序，前3項填寫核心知識產權，並提供相應的證明材料）Proof of Intellectual Property Rights (IPR) (IPRs should be listed in descendingorder of their relevance to the project and the first three should be core IPRs with relevant supporting materials provided)項目名稱Project Title 知識產權類別Categoryof IPR國家/地區Country/Region授權號IPR No.授權日期Date ofPatentGranted權利人IPROwner發明人Inventor專利狀態(已授權/正在申請/到期失效)Status of IPR(Granted /Pending /Expired)* 聲明：臚列以上知識產權作申請獎項之用時，應已取得申請書中未被列為項目主要完成人的知識產權持有人之書面同意。
項目第一完成人須簽署作實。
* Declaration: Written consent should have been obtained from the IPR owner(s) who are not listed as “Principal Person(s) who Completed the Project” in this application for listing the concerned IPR for the purpose of application for the State Scientific and Technological Progress Award. The first Principal Person who completed the project shall sign to confirm such consent has been obtained.第一完成人簽署:Signature of the First Principal Person who Completed the Project:_____________________________VIII.主要完成人情況Information on Principal Person Who Completed the Project本部由第一頁所列的主要完成人按貢獻大小順序填寫。
如項目由多於一人完成，則所有完成人均須填寫本部。
This part should be completed by the “Principal Person(s) who Completed the Project” as listed in page 1 in order of their contributions to the project. If the project is completed by more than one person, all the persons who completed the project are required to fill in this part.如完成人來自不同的完成單位，便須提交完成人合作關係說明。
詳情請參看本申請書填寫說明的第X部分。
If the persons who complete the project belong to different units, they are required to submit a Description of Collaboration among the Persons who Completed the Project. For details, please refer to Part X of the Notes on How to Complete the Application Form.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200字; not exceed 100 words in English）本人簽名Signature of Principal Person 日期DateIX.主要完成單位情況Information on Principal Unit(s) at which the Project was Completed按第一頁所列的主要完成單位按貢獻大小順序填寫。