STRICTLY CONFIDENTIALInvention Disclosure Form

/ Procedure No / 001
Revision / 007
Form No. / P1
Title: / Invention Disclosure Form (IDF) / Date

UCC’s Intellectual Property Policy requires that a member of the University, whether staff orstudent, promptly report to the University any discovery or invention made bythe individual (or group of individuals) that might be useful, patentable orotherwise protectable.

In order to protect the rights of all members of staff involved it is important for the University to fully determine the facts relating to the invention, design or production of copyrightable material (including software). This Invention Disclosure Form is intended to record the invention and should be lodged with the University's Office of Technology Transfer as soon as possible.

The information in this form may be relied upon

  • to assist the University's patent agents and/or
  • as the basis of a statement of inventorship in respect of a patent (or other registration)
  • to fulfil obligations on the University to notify funding agencies and/or research sponsors of the occurrence of Intellectual Property associated with their funding.
  • To assess the opportunityand means of commercialising the invention.

Incorrect or incomplete information may therefore lead to the patent failing or being invalidated.

The information provided in this form will be treated as confidential and will be used for the sole purpose of assessing and seeking protection of the disclosed invention.

In completing the form, take as much space as is required to clearly and completely answer each question to the best of your knowledge. The space provided after each question is not representative of the amount of space a complete answer requires.

Please append any additional documentation that you consider relevant.

UCC’scurrent Intellectual Property policy can be viewed at:

The Inventors listed under Section 3 of this Form[‘Inventors’], hereby agree that they will only be entitled to that amount prescribed in any rule or policy of the University in force from time to time, relating to the distribution of license revenue for inventions or other forms of intellectual property. The Inventors acknowledge that such policy or rule will change from time to time, and agree that any agreement to pay royalties to them is to be read subject to any such changes, including, without limitation, the calculation of royalties payable to the Inventors.

You will be notified by the staff of the Office of Technology Transfer of their assessment of the invention and the strategy the Office intends adopting to commercialise the invention.

1.Title of invention

2.Type of Intellectual Property

Patents ; Trade Marks; Designs; Copyrights; Confidential Information/Trade Secret

3.Inventors: Please list all inventors

Note: This form requests a list of individuals who contributed materially to the invention.

An inventor is an individual who has made an intellectual or creative contribution to the invention.

The execution of the attached IP Assignment Agreement by all the inventors is a precondition for proceeding with protection and commercialisation of the IP by the University.

Inventor / Position / Institutional Affiliation / Phone/Fax/ email / Home address / Nationality

4.Contribution to the Invention

Each contributor/potential inventor should write a paragraph relating to his/her contribution and include a signature and date at the end of the paragraph. The summary should include whether the individual was for example involved in deciding on a general programme of work or designing particular experiments as well as whether he/she was involved in carrying out experimental work and the extent to which he/she was carrying out other peoples’ instructions.

If there are more than five contributors, please affix additional pages. Please note that if a patent application is filed, inventorship (which has a specific legal definition) will be addressed by a patent agent. If necessary, inventorship will be determined at a later date.

Note: Co authors of publications are not necessarily inventors.

Lead Inventor Contribution
Contribution
Inventor 2 Contribution
Contribution
Inventor 3 Contribution
Contribution
Inventor 4 Contribution
Contribution
Inventor 5 Contribution
Contribution

5.Description of Invention

Select National Research Priority Area (ref research_prioritisation.pdf)

National Research Priority Area
A / Future Networks & Communications / H / Food for Health
B / Data Analytics, Management, Security & Privacy / I / Sustainable Food Production and Processing
C / Digital Platforms, Content & Applications / J / Marine Renewable Energy
D / Connected Health and Independent Living / K / Smart Grids & Smart Cities
E / Medical Devices / L / Manufacturing Competitiveness
F / Diagnostics / M / Processing Technologies and Novel Materials
G / Therapeutics: Synthesis, Formulation, Processing and Drug Delivery / N / Innovation in Services and Business Processes
General purpose of the invention and the problem it solves (short paragraph)
How it works (short paragraph here - please also attach a more complete document as an appendix giving a full technical description of the invention/design (this is to assist in the possible briefing of a patent agent) and include a sketch or sketches of the invention/design as appropriate
Utility: What does it do/could it do
Commercial applications
Advantages and improvements of this invention over existing methods/ materials/ devices/current state of the art (short paragraph)
Developmental stage of invention: e.g. idea, proven concept, prototype available (short paragraph)

6.Date of invention and public disclosure

Please include the following information

Date of invention and how this was documented (include Laboratory book details and reference no. where available)
Have any public disclosures been made? If so, when, where and how (this can include oral communication, journal, abstract, poster, newsletter publication (online or print), thesis).
Accurate data is essential as prior disclosure may affect the possibility of obtaining patent rights
If planning any upcoming publication or disclosure, oral or written, of any aspect of the invention, please provide dates and details for public disclosures.

7.Prior Art

Please include a short summary report of your prior art (patents and publications) searchas an appendix to this IDF. The report should list the closest related patents and publications. In the case of each item, please summarise that technology in a few lines and indicate why your invention is considered novel in comparison to that patent/paper.

Patent search tools you may wish to use include the following

1)Espacenet ( ;

2)the US Patent office;

3)Google ;

4)Free patents online

8.Sponsorship of research

Yes / No
Was the invention developed with funding from any public or private research grant/ contract?

If yes, please complete the following details. Please note accurate details are needed to fulfil UCC’s obligations under research contract.

Contract Number / Project Title / Project Term / Sponsor (Funding Agency/Company name) / Principal Investigator
Yes / No
Are there any agreements in place relating to this invention (e.g. Material Transfer Agreements (MTA), research collaboration agreements, Consultancy Agreements)?
If so, please outline
Please indicate below whether any aspect of the invention was made possible by the use of materials obtained from an outside individual and/or institution and/or company. Obligations to providers of these materials may exist. List all materials and sources.
List all materials and sources.

9.Please list any companies that you think may be active in this area/ interested in the invention.Please also indicate also whether you have any contacts in these companies.

10.Signatures and Witnesses

Inventors’ Signatures

I/We acknowledge that I/We have read and understood this form and UCC’s Intellectual Property and Technology Transfer Policy and have replied to the questions to the full extent of any knowledge available to me/us.

I/We further agree to timely execute all assignments and other documents related to securing intellectual property protection and licensing of the invention and to otherwise cooperate with the Office of Technology Transfer and the patent attorney selected to handle this case.

I/We also agree to make available to the Office of Technology Transfer, upon request, copies of lab notebooks and any other materials which contain information about the invention.

Inventor Name / Inventor Signature / %age contribution / Date
Lead Inventor
Inventor 2
Inventor 3
Inventor 4
Inventor 5

Witnesses’ Signatures

Please have the IDF signed and dated by two independent witnesses. Neither witness needs to have any technical understanding of the invention. This sign-off is to verify the date of the completion of the IDF.

I acknowledge that this IDF was presented to me for witnessing on the date indicated below.

Witness Name / Witness Signature / Date

IDF Version No: UCC 01:01:07Nov 2017