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 Programs

New Plant Variety / Registration

Summary description of the intellectual property

Date of disclosure of intellectual property by intellectual property creator(s) to OTT

INTELLECTUAL PROPERTY CREATOR(S)

First Name

Middle Name(s)

Family Name

Intellectual Property Title

PATENT APPLICATIONS / PATENTS (where applicable)

Provisional Patent Application

PCT Patent Application

Convention Application

Non-
Convention
Application

Application

Number

Publication/
Registration
Number

Date of filing

Country/
Territory

Date of Grant

OTHER FORMS OF APPLICATIONS / 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)

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. license agreement signed with a third party to commercialise, but pre-revenue

Commercialised (i.e. revenue generation stage)

In the designated reporting period, what was the total income received as a result of license or option agreements?

If any product arising from this invention has reached the market, what was the calendar year of the first commercial sale?

Please provide the commercial name of any products, utlising the intellectual property, that have first reached the market during the designated reporting period

In the designated reporting period, how many exclusive licenses and/or options have been awarded? (please provide details below)

In the designated reporting period, how many non-exclusive licenses and/or options have been awarded? (please provide details)

In the designated reporting period, how many licenses and/or rights were granted to small businesses or BEE entities (please provide details)