RECIPIENT

Contact Details

Intellectual Property Title

TYPE OF INTELLECTUAL PROPERTY

 
 
 
 
(Please select one or more)

Undisclosed information / Trade Secret

Invention /
Patent

Design /
Registration

Copyrighted Work

Software / Computer Program

New Plant
Variety/
Registration

SUMMARY DESCRIPTION OF THE INTELLECTUAL PROPERTY

Date of disclosure of intellectual property
creator(s) to Recipient

(Day)

(Month)

(Year)

INTELLECTUAL PROPERTY CREATOR(S)

First Name

Middle Name (s)

Family Name

PATENT APPLICATIONS / PATENTS (where applicable)

Provisional
Patent
Application

PCT Patent
Application

Convention
Application

Non-
Convention
Application

Application number

Publication/
Grant Number

Date of filing

Country/
Territory

Date of Grant

OTHER FORMS OF APPLICATION / REGISTRATIONS (where applicable)

Number

Date of filing

Country/
Territory

Date of Grant

MONTH AND YEAR OF FIRST REPORTING OF INTELLECTUAL PROPERTY TO NIPMO
(please attach copy)

(Month)

(Year)

FUNDING AGENCY
(i.e. the funding agency that funded the conception or development of the intellectual property)

PLEASE INDICATE THE LATEST STAGE OF DEVELOPMENT OF ANY PRODUCT ARISING FROM THIS INTELLECTUAL PROPERTY, ACCORDING TO THE FOLLOWING CATEGORIES

UNDER
EVALUATION
(i.e. no protection,
pending intellectual
property and
market
assessment

DISCLOSED
AND
PROTECTED
(i.e. no decision
and agreement
made to
commercialise)

LICENSED
(i.e. licence
agreement signed
with a third party
to commercialise,
but pre-revenue)

COMMERCIALISED
(i.e. revenue
generation stage)

REASONS FOR REFERRAL
(please provide supporting documents and arguments as required by regulations)

Put into the public domain

Not capable of registration

Release of intellectual property

Unfavourable
Search and/or
examination

Lack of market and
commercial
potential

Do not wish to
retain ownership

REQUIRED ACTION FROM NIPMO

Approval to put in public domain

Approval to release intellectual property

Waiver of rights to private entity or organisation / intellectual property creators