Reference number (Internal use only)
CONFIDENTIAL
Research and Enterprise Division
Technology Transfer
Technology Disclosure Form
The information on this form will be the basis of a decision on the level of support for the commercial development of the
project that will be given by the Technology commercialisation team of the Research and Enterprise Division (RED) and will also
provide an initial brief to any appointed patent agent. Please complete all sections as fully as possible. The questions are a guide
to help you but please add any additional information that you think will be relevant and/or helpful.
The technology commercialisation managers of RED will help you to complete the form, including performing initial searching of
patent and technical literature as necessary.
Main Contact:
Dept:
Email:
Tel:
Title of Disclosure:
Date of anticipated publication or any other disclosure:
Have details of this work been published (give details):
- In a journal?
Yes/No
If yes please attach paper as an appendix
- To a conference or seminar? Yes/No
- In a poster? Yes/No
If yes please attach slides, abstract, synopsis as an appendix
If yes please attach slides, abstract, synopsis as an appendix
Have any materials used in developing the technology been supplied under a Material Transfer Agreement or other similar
agreement? Yes/No If yes please describe materials used and source (university/company name)
List all who have contributed to this work and are/would be named as authors on publications/posters etc
Name
Contribution
Funding
Job Title
Is this work the result of collaboration with any other organisation? If so, please give details (including name of
collaborator, organisation that employs them, contribution to the work
Please list source(s) of funding for the research that led to this disclosure, include grant numbers and start and end date
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What stage of development do you consider this technology to be at:
Conceptual / in development / working prototype (please delete as applicable)
TECHNOLOGY DESCRIPTION
1.
Please provide information under the following headings: Background, Technology, please describe the technology in
detail, including a description of how your technology operates, including diagrams such as flow diagrams, technical
drawings, charts, graphs, etc. as appropriate. Also indicate how many years of development will be needed before the
technology could be realistically licensed or a product sold and indicate the likely development costs.
INTELLECTUAL PROPERTY
2. What is new or novel about the disclosed technology that is not already known and in the public domain? What is the
closest publically available information (include academic publications, patents and relevant websites).
3. What is/are the inventive or creative step(s)? By this it is meant, which aspect(s) of the disclosure do you believe could
not be considered an obvious extension of current knowledge, by the average skilled person working in the area?
MARKET POTENTIAL
4. What is the practical industrial application of the proposed technology? What problem does it solve? Please list the
currently available alternative solutions to the problem. What are the benefits of your technology over currently available
solutions? Who would wish to use your technology/buy the proposed product. Please provide any information you have
about the size of the relevant target market. Is this a well-established market or a new one? What will be the route to
market? Will a licence to other technologies be required? Which are these likely to be? What partners or licensees will be
needed to get to market?
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5. Please provide details of ANY relevant prior disclosure(s): What are the most relevant things you are aware of that have
been published, patented or otherwise disclosed by other researchers, companies etc...? Prior disclosures include papers,
talks, posters, email correspondence and conversations with individuals that are not inventors.
Signed:
Date:
It is essential that your technology, if being considered for protection by patenting, is not disclosed in any way before a patent application is
filed.
Please contact Rebecca Timms ([email protected]) about the date you will be disclosing your invention well in advance of the deadline.
TD Evaluation Summary (to be completed by RED after TD meeting discussion about project)
Please tick one of the boxes and then obtain appropriate signatures
Tier 1 – Proactive Management
Name of TCM ……………………………………………………… Signature of TCM…………………………………………….
Tier 2 – Reactive Management
Name of Director of TC ……………………………………… Signature of DTC…………………………………………….
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