CENTRE FOR INTELLECTUAL PROPERTY RIGHTS

ANNA UNIVERSITY CHENNAI, CHENNAI 600 025.

Sl.No ____
Date:

INVENTION DISCLOSURE FORM

TITLE OF THE INVENTION:

I. CONTACT INFORMATION
1. Name and Nationality of the main inventor:
Name

Home Address

Citizenship

Mobile No

E mail id

2. Name and Nationality of the additional inventors:

Name

Home Address

Citizenship

Mobile No

E mail id

II. FUNDING SUPPORT FOR THIS INVENTION

1. Sponsoring agency:
(a) Was this invention developed under any project funds): YES
(b) If yes Name of the funding agency along with the reference details:

III. ABOUT THE INVENTION

1. Field of the Invention
Confidential IDF, CIPR, Anna University, Chennai - 600 025
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NO

2. Novelty of the invention

3. Innovative features

4. Abstract of the Invention

5. Background of the invention

6. Existing state of art related to the invention (includes patent, literature

search)

a. The kind of Patent search you request (tick)

6.1. Prior art / 6.2 Freedom to operate / 6.3. (Invalidity/Validity)
6.4. Infringement /6.5. Bibliographic / 6.6. Continuing / 6.7.
(Inventor/assignee)
7. Drawbacks in existing state-of-art and how the drawbacks have been overcome
and advantages of your invention.

8. Detailed description of the invention

Confidential IDF, CIPR, Anna University, Chennai - 600 025

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9. Industrial application of the invention

10. List of keywords (in capital letters) relevant to the invention

IV. PUBLIC DISCLOSURE

1. Has the invention been described or discussed in any journal, abstract paper, oral
presentation, news story, thesis or other medium? YES

NO

a) If yes give the details

V. USE OF PROPRIETARY MATERIALS

1. Indicate whether any part of the invention is based on, or was made possible by
the use of,
Proprietary material(s) or special technique(s) obtained from a third party (such as a
company or
another institution).
2. Did this research use any biological material from outside? YES
NO
a. If yes, please mention the geographical origin of biological material used for the
invention

b. If so, have you deposited the biological material in an International Depository

Authority? YES

NO

c. Name and address of the International Depository Authority

d. Date and number of deposition of Biological material:

Confidential IDF, CIPR, Anna University, Chennai - 600 025
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VI. MARKET EVALUATION

1. Whether your invention is concept only, laboratory tested or prototype.

2. List the products or process that competes with your invention?

3. Suggest few companies (along with their complete contacts) which may be
interested in your invention?

4. Approximate commercialization value of your invention:

VII. GENERAL INFORMATION

(Only for the invention of Anna University which are not sponsored
through funding agency)
19. List of three expert members (along with their complete contact details) in the
field of proposed invention (preferably in and around Chennai).

VIII. SIGNATURE PAGE

I/We the undersigned inventor(s), through my/our activities at Anna University,
hereby
disclose this Invention to the CIPR, Anna University Chennai on the date last
signed below. I/We understand that my/our obligations regarding this Invention
are governed by the Anna University IPR Policy.
Signature of the Inventor(s)

Confidential IDF, CIPR, Anna University, Chennai - 600 025

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By:
Name:

By:
Name:

Date:

Date:

By:
Name:

By:
Name:

Date:

Date:

( Attach additional Signature Pages, if necessary)

Please submit the completed Invention Disclosure Form, Detailed Specification of
the invention and Signature Page signed by all inventors to:
The Director,
Centre for Intellectual Property Rights,
Anna University Chennai 600 025
FOR OFFICE USE ONLY
1. Name of the Person who made the Search:
2. Kind of search made
Prior art / Patentability / Freedom to operate / (Invalidity/Validity
Infringement /Bibliographic / Continuing / (Inventor/assignee)
3. Name of the person who drafted the specification:
4. Kind of specification: 1. Provisional 2. Complete
5. Date of Filing the provisional specification to the patent office:

/20

6. Date of Filing the Complete specification to the patent office:

/20

7. Date of request for publication:

8. Date of request for examination:

/20
/

/20

9. Initiatives taken for commercialization:

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10. Actions taken by the patent office:

11. Details of any pre grant oppositions filed:

12. Date of counters filed to the Patent office:

14. Date of Grant of patents:

/20

15. Details of any post grant oppositions:

16. Details of Final Decision on the Patent:

Confidential IDF, CIPR, Anna University, Chennai - 600 025

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