ࡱ>  bjbj LZ @w]t;++++ "*%H\\\\\\\_aj\I( I(I(\++d]111I(R++\1I(\11jX[+P{0(Z2\z]0]Z *b)*bd[*b[r&L&61&, ')r&r&r&\\0 r&r&r&]I(I(I(I(*br&r&r&r&r&r&r&r&r& : UNIVERSITY OF SUSSEX IN CONFIDENCE INTELLECTUAL PROPERTY DISCLOSURE FORM Information provided on this form will help the IP Manager decide whether the University is the owner of intellectual property and assist with the assessment of its commercial potential. It will be used by the University in reaching a decision on whether protection and commercial exploitation is appropriate and what form such exploitation should take. It may be used in negotiations with third parties. Please complete this form as fully as possible. Name and address of Inventor completing this form Name: FORMTEXT      Address: FORMTEXT       Phone:  FORMTEXT      Fax: FORMTEXT      Email: FORMTEXT      Date:  FORMTEXT       The Intellectual Property Descriptive Title of Intellectual Property: FORMTEXT       In as non-technical language as possible briefly describe the intellectual property, the theory underlying it, what it does, what is new about it, what problem it solves (attach any papers, write-ups, drawings etc that will help): Keywords:  FORMTEXT       2. Who Made the Intellectual Property? Is the intellectual property all your own work? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If YES, only complete the information about yourself. If NO, please give the names of all those who contributed to making the intellectual property and their relative contribution. Inventor(s):NameHow is the post funded?% contributionUniversity Employees: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      University Students: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Non-University: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      If non-university staff or students involved, please explain the circumstances: FORMTEXT       3. When was the Intellectual Property Made? Approximately, over what period of time have you (and any co-inventors) been working on the research that has led directly to the intellectual property? Is there a specific  Eureka date? FORMTEXT       Is the intellectual property reliably documented? Have you (and/or any co-inventors) been keeping a full and certified record of the research that has created the intellectual property? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) 4. Associated Funding Was the intellectual property made under a contract with a third party (e.g. a research contract, a material transfer agreement)? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If YES, enter University Grant Number or other reference below and name of other party: FORMTEXT       5. Third Party Interests Does the intellectual property rely on the use of third party owned materials or information? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If YES, please provide details of extent and nature of reliance or use and the circumstances: FORMTEXT      Is the intellectual property partly based on, or does it use or depend on, an earlier piece of work by you and/or any co-inventors? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If YES, when was the earlier work done (please give dates)? FORMTEXT       Were you (or any co-inventors) employed at this University at the time? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If NO, who was your (any co-inventors ) employer? FORMTEXT       Do you think that this employer has a claim to the earlier work? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If YES, extent of claim FORMTEXT      If NO, why not? FORMTEXT       6. Publication Has the intellectual property been published (e.g. poster, abstract, conference presentation, book, journal paper, thesis, on the Internet) or in any other way disclosed to anyone else either by you (or any co-inventors) or others? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If YES, was it disclosed under the terms of a confidentiality agreement? YES  FORMCHECKBOX  NO  FORMCHECKBOX  (tick appropriate box) If YES, please attach a copy of the confidentiality agreement. 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L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.&Jf#hlW'bSnT3 gA9QO>M0 La;g11 ^NgUL]e hp;-EC(,)}a>w@@xh ^`OJQJo(o9z;        @3o        q c(F,D/ct9IC]OD3!PAiClAl{U}/30!;E{B=d>9L?c$:ZtxZ\@*** * * * ***%h@  @0@ "H@vUnknownG* Times New Roman5Symbol3. * Arial?= * Courier New;WingdingsA BCambria Math"qh Ғ&a5a5!24dLL3QHX ?2!xxANNEX 2 Julia Fallon Keith O'Briend                 Oh+'0 $ D P \ ht|ANNEX 2Julia Fallon Normal.dotmKeith O'Brien6Microsoft Office Word@Ik@$GD@hC@a՜.+,0 hp  The պ5L ANNEX 2 Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghjklmnopqrstuvwxyz{|}~Root Entry F080Data i4Q1TablebWordDocumentLSummaryInformation(DocumentSummaryInformation8CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q