Inter University Centre for Ipr Studies

INTER UNIVERSITY CENTRE FOR IPR STUDIES

COCHIN UNIVERSITY OF SCIENCE AND TECHNOLOGY

Request Date:

Invention Disclosure Form (Confidential)

[While filling the format, please delete the guidance cues (in grey) under each heading]

1. Inventor(s) information [Please fill out Annexure-A and attach]

(i) / Name
Position
Department / Organisation
Phone & E Mail
(ii) / Name
Position
Department / Organisation
Phone & E Mail
(iii) / Name
Position
Department / Organisation
Phone & E Mail
(iv) / Add if there are more inventors

2. Applicant (s) information: Registrar of the University should be the first applicant

1st Applicant / 2nd Applicant
(i) / Name of the University
Contact Name / Position
Address
Phone & E Mail

In case of joint application along with any other institution/s, attach the letter of the consent obtained from that institution/s to file a joint application.

3. Address for communication

Name: ------

Address: ------

Phone and e-mail

4. Title of the invention:

ü A slightly descriptive title to identify the nature of the invention (not more than 15 words)

5. Field /Area of invention

ü One or two sentences mentioning the specific technology area of the invention

ü Please provide a list of key words, which would define your invention.

6. Summary and background leading to the invention

ü A brief narration of the background of the invention followed by a summarized description of the invention (in a paragraph). It could be written with a problem-solution approach.

ü Advantages of the invention over what is already known, may also be provided here.

7. Description of the invention in detail (Key references to be cited here. Detailed document may be attached separately and shared with the Consultant as required)

ü The invention should be described without withholding any key information. If the inventor has prepared any draft manuscript for future publication, it may be shared in lieu of detailed description.

It may be written in a simple manner. A person who is having ordinary skill in the area of research should be able to understand the description and reproduce/carry out the invention without any undue experimentation.

ü Any modification or alternative forms of the invention may be described.

ü In case of the inventions that are not yet completed (conceived to be workable, but not yet worked out), they may be described as hypothetical examples. They should be described in such a way how they should be actually performed.

ü Any supporting data related to the invention such as drawings, illustrations, test data, graphs, charts, etc.

8. Prior publications / Patents by /available with the inventors

· Has the same or a part of the invention been published or presented in a public forum by the inventors? If yes, please provide the details. If no, please share any other publications/presentation by the inventors relevant to the area of the current invention.

ü Please also share the details if the inventor has already filed any patent application in the related area. If the patent application is published or granted, please give the number. If it is not published yet, an abstract may be shared.

ü The list of references (patent & non-patent) that the inventors may feel relevant to the invention, or serving as the background for the invention. If patent search has been already done, enclose report.

9. Support information

ü Has any external funding sources being used for the research? Has any government funding been used for the research- Please provide details. (Project Title and UO number)

ü Please attach copy of agreements with funding agencies and sponsoring agencies. Clarify where, rights to any intellectual property arising out of the project, would lie.

10. Applications and commercialization [Please provide additional info in Annexure – A]

ü Please describe where the invention may be used. Is there a direct contact with any agency or commercial enterprise which might be interested in pursuing commercialization of your invention? If yes give details.

ü Are there any commercial enterprises, which might be interested in pursuing the commercialization of the invention? If yes give details.

11. Disclosure Information

ü Has any disclosure been made to any person, whether public or confidential eg. Publication in journals, discussion with suppliers or potential partners. If yes give details.

12. Any other relevant information

ü Is there any urgency on account of publishing in a journal; presentation at a seminar; response to competition etc. If yes, a provisional specification should be filed prior to the same. Details provided for patent filing should cover all that is to be published and more. Please indicate target date for action.

13. Requested Action: Tick as appropriate

Provisional Filing Complete filing Including Examination

ü In case of provisional filing, please indicate timeframe in which complete filing would be taken up.

14. Undertakings:

a. I/We hereby undertake that I/We have not published and shall not publish the details of the invention in any publication until the patent application is filed in the Indian Patent Office.

b. I/We hereby assign all my/our rights in the invention in the name of patent applicant/s ------(University concerned/institution/s) for the purpose of filing the application in their names and to enjoy all the rights once granted.

c. I/We also undertake to sign necessary forms transferring our rights at the time of filing the patent application.

I/We request you to kindly file the patent application in the name of ------(name of the University/institution/s) through the IPR Facilitation Cell of IUCIPRS

Signature with date

NB: Annexure ‘A’ is to be filled out and attached with this form

Consultant engaged by the IUCIPRS will request a “Detailed Invention Disclosure” to ascertain the Novel and Inventive features of your invention, as also to finalize claims of your invention.

Certificate from the Registrar

This is to certify that the inventor/s mentioned in column 1 is/are employee/s of this University/ affiliated Colleges and I hear by authorize the IUCIPRS to take steps to file a patent application in India in the name of the Registrar of the University/and ------(name of the Institution/s if it is a joint application). I also undertake to sign all forms/documents necessary for the purpose of registration of patent in the Indian Patent Office.

Registrar

------(name of the University)

Place ------

Date ------

ANNEXURE A: COMMERCIALISATION

a. Marketing Title & Brief Description:

A write-up [limited to 100 words]

Disclosure may be broad, without divulging detailed technical information

b. Development Status [Readiness for Market]

Only a Concept Lab tested Pilot tested Field tested

Clinical Data available Others Ready for Market

……………………………………………………………………………………......

c. Commercial Potential / Market Attractiveness

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· Application Industry

Agri based / Automotive / Bio Medical Engineering
Capital Equipment/ OEM / Electronic System & Design Manufacturing / Energy / Infrastructure
Environment Engineering / Information & Communication Technology / Manufacturing / Chemical
Other Technologies / Special Needs

· Industry sub-categories

……………………………………………………………………………………......

· Comments

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e. Ease of Implementation / Championing by Inventor (Give details)

· Existing Relationships

· Contacts in Companies, Industry associations or other bodies who may be interested.

d. Timing, Risk factors, Regulatory, etc. (Give details)

Time required for commercialization ------

Risk factors ------

Regulatory approvals required for commercialization ------

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e. Commercialization Responsibility [Please tick as relevant]

University : Licensing Portfolio Start-ups

Joint Marketing : Co-applicant Commercialization Partners

……………………………………………………………………………………......

f. Financial Analysis:

Costs / Cost Sharing (Estimate) / Revenue / Other Benefits [Estimate]
...... / ......
...... / ......

Progress of Commercialisation

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