Panasonic Ref*:
`(* must befilled)
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`P636217
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`Japan Firm Name:
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`IPSG
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`Application Serial No.
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`Japan Firm Ref:
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`P635217
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`US Firm Name:
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`RP
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`US Firm Ref:
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`Declaration Form 3.1 (Jan. 2009)
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`DECLARATION AND POWER OF ATTORNEY FOR U.S. PATENT APPLICATION
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`(c) l: Substitute
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`(d) I: PCT
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`(9)
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`Design
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`(a) I Original
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`(b)
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`Supplemental
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`I hereby declare that: my residence, post office address and citizenship are as stated
`As a below named inventor,
`below next to my name; and I believe that I am the original, first and sole inventor (if only one name is listed below) or an original,
`first and joint inventor (if plural inventors are named below) of the subject matter which is claimed and for which a patent is
`sought on the invention entitled:
`Title of Invention:
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`PHOTORADIATION DEVICE AND PHOTORADIATION THERAPY/PROPHYLAXIS DEVICE
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`COMPRISING SAME
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`which is described and claimed in (if the following box is not checked, the specification of which is attached hereto):
`1. For use when submitting this Declaration grior to U.S. agplicofion filing dale
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`(f) _ the attached specification, or
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`2. For use when submitting this Declaration after US. agilicationfi/ino date
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`-
`-
`-
`filed on:
`A lication No.
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`
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`the s'peCIfication in the US.
`magi/able)
`(Wm (WM)
`Application:
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`and with amendments (if applicable):
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`3. For PCT-U.S' national entry under 35 U.S.C. 371 0?)!” use when filing this Declaration before and after the US. national entry date)
`(h) I the specification in the
`PCT
`filed on:
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`Application No. PCT/JP2012/005243
`(PCTfiIingdnre)
`AUQUSt 22‘ 2012
`International Application:
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`(Q)
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`(Check here onlyfor US national all“)? undo/'35 U,S.C. 371.)
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`
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`and Wlth amendments (If applicable): filed on:
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`I hereby state that l have reviewed and understand the contents of the above-identified specification,
`claims, as amended by any amendment(s) referred to above.
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`including the
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`I acknowledge my duty to disclose to the US. Patent and Trademark Office all information known to me to be material
`to patentability as defined in Title 37, Code of Federal Regulations, §1.56.
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`l hereby claim foreign priority benefits under Title 35, United States Code, §119 (a-d), §172, or §365(b) of any foreign
`application(s) for patent or inventor‘s certificate, 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 any foreign application for patent or
`inventor's certificate, or of any PCT international application having a filing date before that of the application on which priority is
`claimed:
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`2011-191348
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`September 2,2011
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`a Additional foreign or international application numbers are listed on a supplemental priority sheet attached hereto.
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`

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`Declaration Form 3.1 (Jan. 2009)
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`I hereby claim the benefit under Title 35, United States Code §119(e) of any United States Provisional application(s)
`listed below.
`US ProvisronalA -/icatian Information
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`
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`1:: Additional US. provisional application numbers are listed on a supplemental priority sheet attached hereto.
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`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 of America, 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 material to
`patentability as defined in Title 37, Code of Federal Regulations, §1.56 which occurred between the filing date of the prior
`Domestic Priori
`Information
`application and the national or PCT international filing date of this application.
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`
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`El Additional US. or international application numbers are listed on a supplemental priority sheet attached hereto.
`POWER OF ATTORNEY: As a named inventor,
`I hereby appoint the attorneys and agents associated with US. Patent and
`Trademark Office Customer Number identified below to prosecute this application including divisions, continuations and reissues
`thereof in the United States and to transact all business in the US. Patent and Trademark Office connected therewith, and direct
`that all correspondence be addressed to that customer number.
`
`I hereby authorize the US. attorneys and agents associated with the customer number to accept and follow instructions
`from Panasonic Corporation and any affiliated or subsidiary company thereof, received via their corporate representatives and/or
`their foreign patent attorneys or agents, if any, as to any action to be taken in the US. Patent and Trademark Office regarding
`this application without direct communication between the US. attorneys or agents and myself.
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`Power of Attorney given to practitioners associated with, and direct Correspondence to:
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`RatnerPrestia
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`CUSTOMER NUMBER
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`52473
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`l further 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 or any patent issuing thereon.
`INVENTOR s
`Full Name of Sole or First
`Inventor
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`SIGNATURE
`'
`,
`'
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`[p 12 .'
`’
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`.
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`DATE OF SIGNATURE
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`Jar/L. 7 20/
`CITIZENSHIP
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`A“
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`”
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`Japanese Post office address
`ZIP CODE
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`Residence & Citizenship
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`LAST NAME
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`FIRST NAME
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`DAIJO
`Kazuhiro
`CITY, STATE or COUNTRY
`Osaka, Japan
`ADDRESS
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`CITY
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`STATE OR COUNTRY
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`ZIP CODE
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`c/o Panasonic Photo & Lighting Co., Ltd.
`1-1, Saiwai-cho, Takatsuki~shi, Osaka 569-1193 Japan
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`Full Name of
`Second Inventor
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`FIRST NAME
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`LAST NAME
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`SIGNATURE
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`DATE OF SIGNATURE
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`Residence 8. Citizenship
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`CITY, STATE or COUNTRY
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`CITIZENSHIP
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`Post office address
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`ADDRESS
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`CITY
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`STATE 0R COUNTRY
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`Cl Check if additional paper(s) is/are attached. Total of 2
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`pages are submitted.
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