INTELLECTUAL PROPERTY
DISCLOSURE FORM

Information provided within will not and should not be disclosed to others without appropriate confidentiality restrictions in place or the advice of Research Development and Innovation.

1. Title of Invention/Discovery
Title of Project
Project keywords

2. DESCRIPTION OF the iNVENTION / DISCOVERY

What is the Invention / Discovery? What does it do?
What are the unique features of the invention? What are the benefits of the unique features?

3. Use of Invention / Discovery

How and where could this be applied?
What problems or limitations does this Invention / Discovery overcome?
Which companies might find the Invention / Discovery useful and why?

4. Funding and Third Party Associations

Please list all grants and other funding sources associated with this Invention/ Discovery.
Are there any agreements (such as MTAs, CDAs, licence and collaboration agreements) that are associated with this Invention/ Discovery?
Does the invention rely on use of third party owned materials or IP?

5. ORIGIN & PRIOR DISCLOSURE OF THE INVENTION / DISCOVERY

Provide the date of the Invention / Discovery.
Has the Invention / Discovery been disclosed? If so, provide details.
Please provide details of any planned disclosures.

6. OTHER RELEVANT INFORMATION

Have you checked scientific and patent literature most relevant to this Invention / Discovery?
Are you aware of anything similar in the field? If so, please provide details.
At what stage of development is your Invention / Discovery?
Is the Invention / Discovery an idea, or a proven concept or a working prototype?
What needs to be done next?

7. CONTACT DETAILS

Please list anyone who has contributed to the development of the Invention / Discovery, both from UWA and outside of UWA.
1. Name / Tel
University/Institute / Dept
Email
2. Name / Tel
University/Institute / Dept
Email
3. Name / Tel
University/Institute / Dept
Email
4. Name / Tel
University/Institute / Dept
Email
5. Name / Tel
University/Institute / Dept
Email
6. Name / Tel
University/Institute / Dept
Email
8. AUTHOR OF IP DISCLOSURE
Please provide the name of the person that has filled in this form and is submitting it to OII.

PLEASE FORWARD THIS COMPLETED FORM TO:

Simon Handford

Associate Director, Research Development and Innovation,

IP Disclosure Form – April 2014 Page 2 of 3

Confidential