E r f i n d u n g s m e l d u n g
|From/Contact: | | |
|Name, first name, title | |Phone | |
|Dept./Cost Unit | |Fax | |
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| To the |Received: |
|Office of Technology Transfer | |
|Dr. Ruth Herzog | |
|Dept. T010 | |
|- Internal - | |
Please send only in a sealed envelope (not by fax or e-mail).
Original to Technology Transfer
INVENTION DISCLOSURE
Material REPORT
I do hereby report the invention specified and explained/the material specified below and provide information on the same as follows:
1. Name/Working title of the invention or name of the material (e.g. antibody, cells):
(For material reports) When was the material made?
2. To explain the invention/the material, please answer the following questions:
(a) The invention/The material is connected with knowledge I have acquired at the DKFZ:
Please tick where appropriate: yes no
(b) The invention/The material is connected with my field of work:
Please tick where appropriate: yes no
NOS 3–8 DO NOT HAVE TO BE COMPLETED IF YOU ARE REPORTING A MATERIAL.
3. State of the art
(Everything made available to the public prior to the invention. Detailed information on what, to the best of your knowledge, is the relevant state of the art/sources in the literature. Please use an additional sheet of paper for this, if necessary. Please provide copies of the literature.)
a) Own publications (published patent applications and patents, publications in periodicals, posters, lectures, Internet, transferred material and other publications):
b) Foreign publications (published patent applications and patents, publications in periodicals, posters, lectures, Internet, transferred material and other publications):
4. Description of the invention
● Please describe the essentials of your invention
● Which problem is the invention intended to solve? (e.g. inadequate treatment methods for certain types of tumor)
● How has this problem been solved hitherto? (e.g. known treatment methods and therapeutic substances for the relevant type of tumor)
● What are the advantages of your invention compared with the known solutions?
● Wherein lies the novelty of your invention compared with the known solutions?
● Sample embodiments of the invention: e. g. the most important scientific findings of the investigation; specific compounds (nucleic acids, antibodies?); special methods
5. Have you already disclosed your invention in any way whatsoever, whether in writing or by word of mouth?
Please tick where appropriate: yes no
If yes: When, where and how (seminar, poster, lecture etc.)?
6. Did the invention come about in the course of work on a degree or doctoral dissertation?
Please tick where appropriate: yes no
If yes: Has this dissertation already been submitted for assessment?
7. Is publication of the invention planned?
Please tick where appropriate: yes no
If yes: (probably) on:
Conference, book, periodical:
8. Has there already been contact with industry?
Please tick where appropriate: yes no
If yes: Please specify:
If not: Is contact with industry planned?
Please tick where appropriate: yes no
If yes: Please specify:
9. Did the invention/the material come about in the course of a research, development, licensing or cooperation agreement (e.g. with another research institute or company), or in the course of a project with third-party funding (e.g. DFG, BMBF, NGFN, EU)?
If yes: Please specify:
10. Which people were involved in the invention/the material?
The names provided here should be listed in the order in which they are to appear in later publications. The sum of the percentages due to each of the inventors named and the inventors’ total share must always be 100%.
|Name |First name |Cost Unit |Phone, |Private address |Nationality |Share in % |
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|Externals (freelance inventors, staff of other scientific institutes and/or companies); the name of the said institute and/or company and the |
|private address must be specified. |
|Name |First name |Compa-ny/ |Phone, |Private address |Nationality |Share in % |
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11. Nature and scope of involvement in the invention
If several inventors were involved, the nature and scope of the contribution made by each individual co-inventor named in No. 10 must be specified. (A co-inventor is someone who has made a creative contribution to the invention. The performance of routine measurements, for example, does not constitute a creative contribution.)
|Name |First name |Scope of contribution |
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12. Declaration
By appending my signature/our signatures below, I/we do hereby declare that I/we made the invention/material described/specified in this disclosure, and that to the best of my/our knowledge, no one other than the persons named in No. 10 was involved in making the said invention/material.
I/We undertake to provide all the declarations and signatures required for the patent offices without delay.
I am/We are prepared to support the DKFZ actively in the exploitation of the invention/material specified above. If I/we leave the DKFZ, I/we undertake to provide the Office of Technology Transfer of the DKFZ with a private address and to notify it of all future changes of address, too.
We do hereby nominate
as lead inventor for the purposes of the processing of the invention and any patent applications ensuing from the same, and as contact person for all the declarations required under the German Employees’ Inventions Act (ArbEG).
He/She has been duly empowered by us to represent us in all matters relating to the invention specified above and any patent applications ensuing from the same (excepting the withdrawal of patent applications and patents) and in respect of all the declarations required under the German Employees’ Inventions Act (ArbEG).
Heidelberg, (date)
_______ Enclosures
|Name |First name |Signature |
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Heidelberg, (date) ________________________________
Head of Dept.
By appending this second signature, I/we do hereby confirm that, with the exception of the instances specified in No. 5 above, I/we did not disclose the invention specified above (in scientific publications, conference papers, abstracts etc.) prior to the date of the patent application, and do hereby undertake not to make any such disclosure as could jeopardize the novelty of the aforementioned patent application.
Heidelberg, (date)
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Heidelberg, (date) ________________________________
Head of Department
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