Disclosure form for filing a Patent /Design/Trademark/Copyright
application through FITT
*Publication/public disclosure of the invention before patenting is not advisable and should be avoided.
PATENT INVENTION DISCLOSURE
1.
APPLICANTS :
(a)
Indian Institute of Technology Delhi , Haus Khas, New Delhi 110016
(b)
(c)
(Relevant MoU / Letter of request to be appended)
2.
TITLE OF THE INVENTION :
3.
NAMES OF THE INVENTORS :
(Please give complete names along with designations; in case of inventors outside IIT
Delhi, please provide their contact details)
(a) ___________________________________________, Principal Investigator
(b) ____________________________________________, Co-inventor
(c) ____________________________________________, Co-inventor
(d) ____________________________________________, Co-inventor
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4.
PUBLICATION OR DISCLOSURE OF THE INVENTION
(a) Whether the invention is disclosed before in public by publication /presentation
/poster/display/launch
(b) Please provide details of such publication including title, date, etc.
(Kindly append documents supporting the same)
5.
SPONSORING AGENCY DETAILS (Kindly append any Terms & Conditions,
MoU/Agreement therewith)
6.
INFORMATION ON STAGE OF THESIS (UG/PG/Doctoral) :
(a) Thesis has been submitted and date of submission:
(b) Expected date of thesis submission:
7.
USE OF BIOLOGICAL MATERIAL & INVOLVEMENT OF TRADITIONAL
KNOWLEDGE ( Kindly give the details if any use of biological material has been
made for the invention or any traditional knowledge is involved.)
8.
BACKGROUND
(a) What led you to create this invention / what are the problems intended to be
solved by your invention?
(b) Current technologies /products/processes that provide solution(s) for the same
problem(s)
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(c) How does your invention address/improve on the drawbacks and deficiencies of
available solutions?
9.
DETAILS OF INVENTION (
Kindly enclose a brief abstract of the Invention highlighting the novel features thereof
along with a few keywords in order to facilitate a patent search on the subject.)
(a)
Whether your invention relates to a Product / Process / Both
(b) Novel Features of the invention
(c) Use /Applications of invention.
(d) Alternatives to your invention (if any)
10.
COMMERCIALISATION DATA (Kindly give the names and complete addresses
of different companies which could be interested in the commercial use of this
technology.)
DESIGN REGISTRATION FORM
Descriptive Title of Article:
Brief Reference to Design Features:
Inventor(s):
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1. Form - How is invention constructed? What does it look like? (Attach photos or drawings
of design from 6 views :Front, back, top, bottom, angle, complete) :
2. Purpose - What does invention do? What is it for? What all structural features are
essential/functional?
3. Ornamentation - What non-functional elements of the design and shape are
being claimed as novel and non-obvious?
4. The ornamental aspect of the design was finalized on (date):
5. The design was disclosed, advertised or published on (date) :
TRADEMARK REGISTRATION FORM
1. Description of the mark ( It should not be more than few lines describing the
characteristics of the mark, what the mark is representing, and current/intended use of the
mark):
2. Copy of the mark (a graphical copy as well as a copy of the mark in black and white in
word format) :
3. The mark shall be used for product only or product and any service?
4. Date of first commercial use of the mark in India, if any. Else we will file it with “Intent
to use” basis (It is possible to file a trademark application with “intent to use basis”) :
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COPYRIGHT DISCLOSURE FORM
1. Title of Work:
2. Authors and Contributors:
3. Location of Work (What facilities or resources were used to create the work (i.e.
department)? Please be specific) :
4. Description of Work (Attach separate pages if necessary) :
5. Prior Agreements:
(Is the work subject to any software licence, material transfer, confidentiality, nondisclosure, collaboration or other agreement, written or oral, not referenced above?)
6. Potential Revenue Sources (What are the potential sources of revenue, if any from this
work?):
Please tick the relevant option with regards to the work
New
Continuation of earlier work
Improvement
Other Forms of IP
1. Title of Work:
2. Authors and Contributors:
3. Location of Work (What facilities or resources were used to create the work (i.e.
department)? Please be specific.) :
4. Description of Work (Attach separate pages if necessary.) :
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I hereby CERTIFY that the particulars herein given by me are correct to the best of my
knowledge and belief.
Signed by:
(Full Name with designation & date)
To
Foundation for Innovation and Transfer Technology
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