Date
Invention Disclosure
‫מינהל המחקר החקלאי מרכז וולקני‬
‫"קידום" ויישום מו"פ בחקלאות‬
CONFIDENTIAL
NOTE: ALL SECTIONS MUST BE COMPLETED BEFORE PROCESSING CAN BEGIN.
INSTRUCTIONS: This form should be completed carefully. It should be typed only. Signatures must be
handwritten. Disclose only one invention on this Invention Disclosure form, and complete the entire form as
fully as possible. Forward the completed form to "Kidum" signed and dated by all inventors in hard copies and
email.
The form is filled by:
Institute:
Title of invention/variety:
Field of invention:
Description of invention/variety: (Technical Description of the Invention, What additional research is
needed to complete development and testing of the invention? Alternate Technology: How is the problem
that this invention addresses currently solved) in the case of new varieties of plants (commercial traits of
the variety, designated countries (consumers and growers))
Applications (Functions and possible commercial uses, Products, Contribution to Israeli agriculture, list
any commercial entities that may be interested in this invention):
Technology Highlights (State key points for marketing purposes. the information stated will be forwarded
to relevant companies and commercial entities. Please do not state any confidential information)
STAGE OF DEVELOPMENT: Please check which of the following most closely describes the current stage
of your invention.
Concept Only
Preliminary Data
Prototype Available (If applicable)
Intermediate Data
Complete Proof of Concept
Plant
Have you published any papers, concerning this invention, anywhere in the world?
In the case of new varieties of plants, has plant material
Yes
No
If so, when?
been sold, marketed or transferred to a third party?
Yes
No
Do you intend to publish a paper in the near future?
Yes
No
If so, when?
Do you agree to coordinate the timing and content of publication or the protection of your invention?
Yes
No
Page 1 of 3
Inventors/breeders:(State employees only)
Full formal Name
I.D. No
Share in Invention
Share of research
%
royalties %
Signature
The invention/variety was funded by:
The invention/variety registration will be funded by:
ARO IP budget
Research budget
Company
Other
If the registration of the invention/variety will be funded by the IP budget these amounts will be returned to the IP budget when the
invention/variety will be commercialized and royalties will be received.
Was there any person involved in the invention/variety who is employed by another institution?
Yes
No
If checked yes for the above question, please complete the form in the last page of this disclosure in details.
SIGNATURES: By signing, the signee(s) confirm: (1) the completeness and accuracy of the information in
this disclosure; (2) the willingness of the inventor(s) to cooperate fully with the ARO (Kidum) during the
evaluation, patenting (if appropriate), assignment of rights to the ARO, and commercial development of this
invention; and (3) their percent contribution to the conception and development of the invention which will be
used to determine each inventor’s revenue share, regardless of inventorship status. (Inventorship per se is a
legal determination based on an individual’s intellectual contribution to the claims in a patent. Its determination
must wait until a patent application is filed and will be made with the aid of a patent attorney.) If the percent
contribution of each investigator is not indicated, it will be assumed that each contributed equally.
Signature of leading inventor/breeder__________________
Signature of the head of the institute __________________ date _______________
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Statement with regards to distribution of rights in the Invention
With another Research institute / Commercial company / Farmer
Title of invention/variety("Invention"):
Inventor / breeder declare that the relative contribution to the Invention is as detailed below
The collective share of each Research institute / Commercial company / Farmer will define the "Fixed Ratio"
Inventor / breeder also declare that the fixed ratio will define the following topics:
1. Participation in IP registration cost- The Parties shall bear the costs related to IP registration handling,
protection and maintenance ' in accordance with the Fixed Ratio, as long as no commercial entity has
undertaken to pay such expenses, or in the event that such commercial entity ceases, or fails, to pay same.
2. Sharing the commercial returns - Incomes received from commercialization of the Invention shall be divided
between the Parties in accordance with the Fixed Ratio.
Full formal
Name of
inventor/
breeder
research
institute/
company/
farmer
I.D. No
Share in
Invention
%
The fixed ratio of
Research institute/
company/farmer %
Signature of
inventor/
breeder
Stamp and
Signature of
research
institute/
company/ farmer
* The above mentioned is only a recommendation and it is subordinated to the
approvals of ARO and the appropriate committees.
Page 3 of 3
Date