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I. CONTACT INFORMATION 1. Name and Nationality of the main inventor: Nam e Home Address Citizenship Mobile No E mail id
2. Name and Nationality of the additional inventors: Nam e Home Address Citizenship Mobile No E mail id
II. FUNDING SUPPORT FOR THIS INVNETION 1. Sponsoring agency: (a) Was this invention developed under any project funds): YES (b) If yes Name of the funding agency along with the reference details: NO
6. Existing state of art related to the invention (includes patent, literature search)
Confidential IDF, CIPR, Anna University, Chennai - 600 025 2
a. The kind of Patent search you request (tick) 6.1. Prior art / 6.2 Freedom to operate / 6.3. (Invalidity/Validity) 6.4. Infringement /6.5. Bibliographic / 6.6. Continuing / 6.7. (Inventor/assignee) 7. Drawbacks in existing state-of-art and how the drawbacks have been overcome and advantages of your invention.
10. List of keywords (in capital letters) relevant to the invention IV. PUBLIC DISCLOSURE
Confidential IDF, CIPR, Anna University, Chennai - 600 025 3
1. Has the invention been described or discussed in any journal, abstract paper, oral presentation, news story, thesis or other medium? YES a) If yes give the details NO
V. USE OF PROPRIETARY MATERIALS 1. Indicate whether any part of the invention is based on, or was made possible by the use of, Proprietary material(s) or special technique(s) obtained from a third party (such as a company or another institution).
2. Did this research use any biological material from outside? YES invention
NO
a. If yes, please mention the geographical origin of biological material used for the
b. If so, have you deposited the biological material in an International Depository Authority? YES NO c. Name and address of the International Depository Authority
VI. MARKET EVALUATION 1. Whether your invention is concept only, laboratory tested or prototype.
3. Suggest few companies (along with their complete contacts) which may be interested in your invention?
VII. GENERAL INFORMATION (Only for the invention of Anna University which are not sponsored through funding agency)
Confidential IDF, CIPR, Anna University, Chennai - 600 025 5
19. List of three expert members (along with their complete contact details) in the field of proposed invention (preferably in and around Chennai). 1. 2. 3. VIII. SIGNATURE PAGE I/We the undersigned inventor(s), through my/our activities at Anna University, hereby disclose this Invention to the CIPR, Anna University Chennai on the date last signed below. I/We understand that my/our obligations regarding this Invention are governed by the Anna University IPR Policy. Signature of the Inventor(s) By: Name: Date: By: Name: Date:
Please submit the completed Invention Disclosure Form, Detailed Specification of the invention and Signature Page signed by all inventors to: The Director, Centre for Intellectual Property Rights, Anna University Chennai 600 025
FOR OFFICE USE ONLY 1. Name of the Person who made the Search:
Confidential IDF, CIPR, Anna University, Chennai - 600 025 6
2. Kind of search made Prior art / Patentability / Freedom to operate / (Invalidity/Validity Infringement /Bibliographic / Continuing / (Inventor/assignee) 3. Name of the person who drafted the specification: 4. Kind of specification: 1. Provisional 2. Complete 5. Date of Filing the provisional specification to the patent office: 6. Date of Filing the Complete specification to the patent office: 7. Date of request for publication: 8. Date of request for examination: / / /20 /20 / / /20 /20
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