Intellectual Property Disclosure Form

Title of the invention:

Inventor(s) who have contributed or conceived an essential element of the invention, either independently or jointly with others during evolution of the technology concept or reduction to practice:

Name:	
Nationality:
Position:
Department:
Phone:
Email:	Name:	
Nationality:
Position:
Department:
Phone:
Email:	

Brief description of the invention:
How does this invention relate to new processes, machines, compositions of matter, etc.?  Cover the following points:
(a) Describe the invention in details for technical evaluation. Use additional sheets, if required
(b) What is Novel in the invention? 
(c) What is the “inventive” step in your invention? Is the step non-obvious to a person from related fields?
(d) What are the advantages of the present invention over comparable inventors     available in patent literature? Please attach a summary of your patent search.
(e) Has the invention been tested experimentally?  Are experimental data available?

IPR Ownership
1.	Was the intellectual property created with the significant use of funds or facilities of Delhi Technological University?
—	

2.	Please describe any source of funding for the invention (Name of the funding agency and copy of agreement, letter of intent if any, must be enclosed with this form).
—	

3.	What is the source of Salary/Remuneration of inventor/Co-inventor?
—	

4.	Have you presented in any conference, seminar, etc., if yes, please give details?
—	

5.	Have you published full/part of this invention, if yes, please give copy of publications?
—	

6.	Was the intellectual property created in the course of or pursuant to a sponsored/consultancy research agreement with DTU? If yes, please enclose a copy of MOU with concerned project.
—	

7.	Was the intellectual property created as a part of academic research leading towards a degree or otherwise?
—
8.	REVENUE SHARING AMONG INVENTORS: Please disclose the extent of contribution of each inventor in the invention in percentage terms for revenue sharing.

    NAME OF THE INVENTOR          % SHARE*                   SIGNATURE

* If this column is not filled and signed then it will be assumed that all inventor(s) have equal contribution

Commercial potential
Please provide as much information as possible; Attach extra sheets, if required  
1. Give brief description of potential commercializes by specifying
	(a)  Input (Financial) required taking it to best stage.
	(b)  Break even capacity.
	(c)  Can you identify possible end-users?
   (d)  Economic viability

2. Who are the Target companies, both in India or abroad? Name at least three (From customer point of view)

3. Please give specific list of companies and contact details of concerned person who can be contacted for initiating Technology Licensing 
	S. No.	Name of Companies 	Name of the contact person	Contact no.	
—	 —	—	—	

4. Please Suggest 5 TEC (Technical Evaluation Committee) Members

S. No.	Name of TEC Member	         Department	Contact details	
 1.	 	 	 	
 2.	 	 	 	
 3.	 	 	 	
 4.	 	 	 	
 5.	 	 	 	

The TEC members could be any Faculty or Technical staff from DTU, Delhi. The TEC members are supposed to have capability to evaluate the Invention & should be well versed with the domain of the Invention

Development stage:
In your opinion which of the three best describes the current stage of development of the invention as it relates to its marketability (indicate appropriate response):

------------ Embryonic (needs substantial work to bring market)

------------ Partially developed (could be brought to market with significant investment)

------------ Off-the-shelf (could be brought to market with nominal investment)

-------------Do you want to file Patent under PCT Route in other countries? 
         
         Yes                              No                    	
        
*The University shall file patent under PCT route only in those cases wherein industry/company has exhibited interest for commercialization.

Signature of Inventor with date			Signature of Inventor with date