UWI Invention Disclosure Form 1

THE UNIVERSITY OF THE WEST INDIES CONFIDENTIAL

INVENTION DISCLOSURE FORM

Please complete and forward two (2) copies to the Business Development Office, University of the West Indies, Cave Hill Campus, Barbados. Telephone: 246 417-4541; Fax 246 417-4542; email: busdevoffice@uwichill.edu.bb. All information reported will be considered confidential and will be treated as such by the University. The information will be released only through Non Disclosure Agreements with third parties and with the consent of the inventor(s). 1. Title of Invention

THE INVENTOR(S) 2. Name(s) of Inventor(s): 2.1 Faculty: Department: 2.2 Addresses: University: Residence:

2.3 Citizenship and Immigration Status (where applicable) of Inventor(s): 2.4 University Status:

2.5 Telephone Number(s): 2.6 Fax Number(s): 2.7 Email:

UWI Invention Disclosure Form 2

DESCRIPTION OF THE INVENTION Please provide drawings, sketches, photographs, or any data which may help in understanding the invention. 3.a. What is the technological problem (in a product or process) to which your invention

provides an answer or improvement? 3.b. What are the shortcomings of present solutions to the same problem? 3.c. How do you deal with the problem? 3.d. In particular, what are the points of difference between your proposal and existing

solutions?

INFORMATION ON THE RESEARCH WHICH PRODUCED THE INVENTION 4. Where was the research undertaken that resulted in this invention?

5.a. Did the University fund the research from which the invention originated?

Yes No

5.b. Was the research from which the invention originated funded by an outside sponsor? Yes No If yes, please identify: Name of Sponsor: Grant, Contract or Agreement: Does the grant, contract or agreement include any conditions concerning the disclosure or disposition of the invention? Consult the Business Development Office, if you need assistance answering this question. 6. Please list all researchers (including graduate students and postdoctoral fellows) who are,

or have been involved in the research that resulted in this invention.

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OWNERSHIP & DISPOSITON OF THE INVENTION 7. In your opinion, is this invention owned by

the inventor? Yes No

7.b. If no, please explain. 7.c. If yes, please consult Paragraph 2.3 of Part II: Inventions of the University Policy on

Intellectual Property and advise:

(i) I/we wish to submit the invention to the University for the purposes of obtaining a patent or for its commercial exploitation and management under the terms of the University’s Policy on Intellectual Property, Part II: Inventions: Yes No

(ii) I/we request that the invention be appraised by and, if appropriate, assigned to the

University under the terms of the University’s Policy on Intellectual Property, Part II: Inventions: Yes No

(iii) I/we have read the University’s Policy on Intellectual Property: Yes No

Signature:……………………………………… Date:…………………………..

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(iv) We also agree to the following division of our 50% share of net annual income for this invention: Yes No Inventor’s Name:………………% Signature:…………………… . Date:……….………..

Inventor’s Name:………………% Signature:…………………… . Date:……….………..

Inventor’s Name:………………% Signature:…………………… . Date:……….………..

Inventor’s Name:………………% Signature:…………………… . Date:……….………..

Total: ……………….%

The other 50% will be allocated to the originating Department/Institute, Campus and the University on a pro rata basis, according to the affiliation of the Inventors and Paragraph 3 of the University’s Policy on Intellectual Property.

7.f. If you answered NO to 7.c (iv). above, please indicate the proposed division:

UWI Invention Disclosure Form 4

If you have chosen YES to either 7.c (i) or (ii) above, please answer questions 8 to 15. If not, please skip to question 16. 8. Can you provide reference in published literature or patents relating to your invention? Yes No If yes, please state reference: 9. Has any publication or disclosure to others been made? Yes No If yes, please state: To whom? When? Where? 10. Has the invention been tested? Yes No If yes, does a sample or model of your invention exist? Yes No If yes, is it available for demonstration, if patent action is taken? Yes No In the case of biomedical discoveries, please indicated, as applicable, the degree to which your invention has been tested in vitro, in vivo, in animal models or humans: 11. Are figures, tables, photographs or prints, slides, motion pictures, available? Yes No 12. Do you expect to continue work towards improving the apparatus, product or process? Yes No 13. Is there within the next six months a meeting of a learned society or deadline of publication of a scientific journal at which you are anxious to make disclosure? Yes No If yes, please indicate when and where the meeting will take place:

UWI Invention Disclosure Form 5

14. Can you suggest where or how your apparatus, product or process might be used? Yes No If yes, please explain: 15. Have you been contacted by or are you currently communicating with a company? Yes No If yes, please explain: NB. The University has standard Non-Disclosure Agreements under which the information may be shared on a confidential basis with a potential sponsor for the development of the invention. 16. If the invention is wholly owned by the research sponsor under a research agreement, please indicate the proposed disposition of the invention, if known: 17. If the invention is wholly owned by the staff member(s) or student(s) and you wish to proceed independently of the University, we ask that you keep the University fully informed of your intentions or actions to be taken. Please indicate your willingness to do so by signing below: I/we wish to proceed to obtain patents, negotiate licenses etc, and undertake to fully inform the University on intentions or actions to be taken:

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