LAYOUT DESIGN OF INTEGRATED CIRCUIT (LDIC) application FORM
1. TITLE/NAME OF PRODUCT(Please provide clear and concise title regarding the design)
2. DESCRIPTION OF PRODUCT
3. DEVELOPMENT OF INVENTION
(Please provide date start/complete and location)
Commencement Date:
Completion Date:
Date of the work first published in Malaysia:
Number of hours spent to complete the work:
Location:
4. IP CREATORS
(The creator(s) of IP includes any person who is rightfully listed as the inventor, author or originator of the work, who has contributed to the creation of the work and to whom they can assign a definable share of the creation. A creator may be a staff member, a student and/or external collaborators. The IP creators are to agree themselves the share/priorities/order of names for the creation disclosed in this form)
Full Name / Affiliation
(Faculty/Dept) / NRIC/ Passport No/ Student ID / Nationality / Percentage of share (%)
5. FINANCIAL SPONSORS
(Was the IP created with the assistance of any funding? If YES, please complete the table below)
Source of Funding
(e.g. ScienceFund/ FRGS/Internal Funding/etc.) / Project Title / Project No.
(GAMS ID) / Project Duration
(dd/mm/yy- dd/mm/yy)
6. DOCUMENTATION
(Please list down the document title with the name of the author(s). Documentation may include product overview or write-up, user manual, technical manual, specification and/or source code)
No / Document Title / Author(s)
1.
2.
3.
4.
7. THIRD PARTY TOOLS/ITEMS/MACHINE/EQUIPMENT USED IN THE PRODUCT CREATION AND TO RUN THE SYSTEM
8. COMMERCIALISATION
(Please tick (√)in the appropriate box to provide information about the product)
a. / Will the product be marketed in Malaysia::
(e.g. sell, let for hire, trade distribution, offer/expose for sale/hire, etc.)
Yes / No
Not sure at the moment / Others:
b. Will the product be marketed outside Malaysia::
(e.g. sell, let for hire, trade distribution, offer/expose for sale/hire, etc.)
Yes / No
Not sure at the moment / Others:
9. LOGO/MARK ASSOCIATED WITH PRODUCT
(Please provide if any)
10. DECLARATION BY PRINCIPAL APPLICANT(To be completed and signed by the principal applicant)
I hereby declare that the enclosed work (LSID) is eligible for protection automatically as it fulfills the following conditions:
- It is original, i.e. the result of my own/team intellectual effort and not commonplace among creators and manufacturers of integrated circuit;
- It has been fixed in a material form (this includes any form of storage from which reproduction is possible) or incorporated into an integrated circuit;
- The right holder of the layout-design is a qualified person.
And, I also hereby declare that:
- Should there be any commercial exploitation arising from this disclosure (income generated in terms of revenue/royalty/etc), I shall make full and frank declaration to R&C Office, as per MMU IP Policy.
- All statements and information provided above are true and correct, to my best knowledge.
- I have also attached the following supporting documents:
No. / Compulsory documents / Please Tick (√)
1. / All relevant documentation in hardcopy (1 copy)
(e.g. layout design)
3. / Any relevant contract(s)/agreement(s), passing of right from outside party(ies) (if any)
Principal Applicant’s Name / Signature and Stamp / Date
11. RECOMMENDATION BY FACULTY DEAN/DIRECTOR/HOD
(To be completed and signed by the applicant’s superior. Please tick (√) in the appropriate box.)
Recommended / Not Recommended
Remarks:
______
Dean/Director/HOD’s signature & stamp Date
12. SUPPORTED BY COLLABORATIVE RESEARCH & INNOVATION CENTRE
(To be completed by the Director of Collaborative Research & Innovation Centre (CRIC). Please tick (√) in the appropriate box.)
Overall Assessment:
Recommended to IPMC / Not Recommended to IPMCRemarks:
______
Director of CRIC’s signature & stamp Date
13. DATE OF IPMC APPROVAL:
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