Confidential

Invention Disclosure

for Employee Inventions at the Medical University of Graz

According to § 106 (3) UG2002,an invention made by anyemployee or apprentice of the Medical University of under public or private law either at the federal state or at the university, has to be disclosed immediately to the rectorate.

In this invention disclosure, the inventors summarize the most important detailsoftheir invention at the MUG to be forwarded tothe attention of the Organisational Unit of Research Management, Department of Research Funding and Technology Transfer. This information shall be treated as confidential and formsthe basis for the decision regardinga possible takeover by the MUG according to § 106 UG and § 7 PatG respectively. Additionally, the dated and signed invention disclosure is early evidence of the invention. In certain cases this can be usefulinthe defence of the inventors’ and the MUG’s rights versus third parties.

A possible release of the invention to the inventors by the MUG covers only information to the extent as specified within this invention disclosure.

Please fill in this form as completely as possible and print it. Sign it inthe spaceprovided and add a detailed description of the invention including copies of manuscripts, drawings, illustrations, concepts, etc. and send it to:

Medizinische Universität Graz

OE Forschungsmanagement

Technologietransfer

Auenbruggerplatz 2/4. Stock

8036 Graz

If you have any questions, please do not hesitate to call +43-(0)316-385-72033or send an email

Please note: Never send the electronic version of this filled in form via E-Mail or any other confidential information withouthaving protected it from being read, e.g. via password-protected WinZip file!

1. Inventors

Please list all persons involved in the invention (the order is not important):

Name, First Name, Title / Sex / Nationality / Employment status with the MUG* / Affiliation (Organization/ Organisational Unit/Department) / Private Address (Street, Nr, Zip Code, City, Country) / %Shares **
female

male

/ ja
nein
female

male

/ ja

nein

female

male

/ ja

nein

female

male

/ ja

nein

female

male

/ ja

nein

female

male

/ ja

nein

*) Is/Was there public or private employment at the MUG at the time point that the invention was made?

**) The crucial factor is an independent conceptual contribution to the invention.

2. Details of the Invention

a) Title of the invention

b) Description of the problem to be solved

c) Description of the current state-of-the-art, including three keypublications. (Please add these publications to this invention disclosure).

d) Description of the invention – Please describe the key conceptof the invention shortly and concisely (3-4 sentences).

e) Characterisation of the invention using key words

Please add a detailed description of your invention to this form. (manuscripts, concept designs, drawings, illustrations, tables, diagrams, etc.).

f) Novelty– .Please note that prior publication of your invention in any form (orally or in writing) makes patenting impossible! However,after submission of the patent specification at the patent office you arefree to publish.

Already published / Planned
Scientific Journal
Name: / No Yes / No Yes
Date of submission:
Date of publication online:
Date of publication print:
Talk / No Yes / No Yes
Date:
Occasion:
Abstract / No Yes / No Yes
Date:
Occasion:
Poster / No Yes / No Yes
Date:
Occasion:
Seminar / No Yes / No Yes
Date:
Occasion:
Website / No Yes / No Yes
Date of publication:
Page:
Master‘s Thesis
/ No
Yes, but the thesis has been blocked from publication
Date of submission: / No Yes
Date of submission:
Date of publication:
Ph.D. Thesis / No
Yes, but the thesis has been blocked from publication
Date of submission: / No Yes
Date of submission:
Date of publication:

g) Level of maturity / Data available:

Phase of planning Proof of Concept Prototype Animal Model Clinical Data

h) Have property rights already been filed(patents, utility models, etc.)?

Yes no
Details

i) Does a search or examination report of the patent office exist?

Yes no
(Please attach, if available!)

3. Legal Status– Dependency of the Invention

Have any kind of data, materials, expertise, etc. been obtainedfrom a third party in the course of the invention?
yes no
If yes,
have MTAs (Material Transfer Agreements) / yes no
CDAs (Confidentiality Agreements) been concluded? yes no
Have any kind of data, materials, expertise, etc. been transferredto a third party in the course of the invention?
yes no
If yes,
have MTAs (Material Transfer Agreements) / yes no
CDAs (Confidentiality Agreements) been concluded yes no
If so, please attach the respective MTAs und CDAs and listMUG-external persons, companies or organisations concerned.
Person / Organisation / Company / Have rights to the invention been abandoned making it impossible to file a patent in the name of the MUG?
Has there been third party funding / MUG-external funding?
yes no
If so, please listMUG-externalsources of capital (Funds, trusts, otherorganisations, companies)that havefinanced the research leading to the invention. (Please attach the respective (funding) agreements):
Organisation / Have rights to the inventionbeen making it impossible to file a patent in the name of the MUG?

Remarks:

4. Commercial Exploitation

What are the relevant advantages and disadvantages of your invention compared to the state-of-the-art – Please describe (if existing) alternative technologies that can be used to achieve the same aim and how your invention can be distinguished from that.
How can your invention been used commercially (products / indications)?
Forwhat kind of companies / business / industrial sectors could your invention be of interest?
Rough estimation of market potential
(Indications concerning patient numbers, quantity, turnover for Austria, Europe, world wide)
Have there already been efforts of exploitation? yes no
If so, which ones?

I/we herewith confirm to have described the invention completely and comprehensively and to have listed all inventors involved.We agree on the shares of the invention as listed in the last column of the table in clause 1 and confirm them to be correct.

I am/ We are aware that according to §13 Austrian Patent Act, the invention is subject to confidentiality until takeover by the MUG and must not be disclosed to third parties unless and until a confidentiality agreement has been concluded.

Inventors (Name, First Name)

/

Place and Date

/

Signature

Please attachthe following annexes to the invention disclosure

(and check the respective boxes)

Annexes concerning the invention:

...... A description of the invention, as detailed and comprehensive as possible:

What task/problem had to be solved?

What havethe approaches to the problem been so far?

Description of your approach (how do you solve the problem/the task?)

Examples of layout or implementation

Figures

Possible manuscripts or drafts

In case of a planned publication: Text of the publication.

Key publications

Search report of the patent office

Annexes concerning the legal status:

Have there been concludedagreements or are there agreements currently in negotiations:

Third-party funding agreements

MTAs (Material Transfer Agreements)

CDAs (Confidentiality Agreements)

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