antibody_disclosure_form

							                                                                              Antibody Disclosure Form


   This is a Word Form Template; please click on the GREY BOXES, fill in as
                                appropriate.


1. Antibody Information (Completed by Investigator)
Anti- (e.g Anti-CD61):
Please delete as       Monoclonal antibody /                Polyclonal antibody     /
 appropriate:
Clone Name:                                                   Polyclonal Name:
Isotype:                                                      For polyclonals: Amount available?
                                                              (approx 5ml purified sera required for
                                                               commercialisation)
Raised in:
Relevance (Application of
 antibody or relevance of
 target protein etc):
Immunogen (please state it’s origin e.g. synthetic peptide sequence/location, recombinant protein, native
protein from which species):
Epitope (if known):
Positive Control( (e.g. a tissue, cell type or cell line):
Cross Reactivity:
Applications tested(please delete as appropriate):

ELISA                 /           Western                  /          Neutralising                 /
ChIP                  /           Paraffin Embedded        /          Immunoprecipitation          /
Acetone Fixed         /           Frozen                   /          Immunofluorescence           /
RIA                   /           FITC                     /          FACS                         /
Other Applications (detail:         )                        /

Are there images available for any of the above (Images significantly increase commercial interest), please
include in return message?
Recommended Growth Conditions:
Myeloma fusion partner used:
Suggested dilutions in specified applications (If known):
Published References (please include PubMedID):




   Registered office: Sardinia House, Sardinia Street, London WC2A 3NL. Registered in England number
  1626049. VAT registration number GB788 138678. A wholly-owned subsidiary of Cancer Research UK,
                                       registered charity no. 1089464.
                                                                                 Antibody Disclosure Form


2. Origin of Material (Completed by Investigator or CRT)
Describe the origins / ownership of the immunogen used to general the antibody (the first line is an
example)
Immunogen/Antigen                    Origin                          Conditions of Transfer / Freedom of
                                                                     Use (Please include documentation)
(e.g. Recombinant fragment of        (e.g. Prof I Wood,              (e.g. Academic MTA)
human XYZ protein produced in E. iwood@university.edu)
coli (amino acids 123-153) )




4. 3rd Party Institute Obligations (Funding Agency / Revenue Share / In-licensing). (Completed by
Investigator or Newcastle Research & Enterprise Services or CRT)
List ALL 3rd party institutes (host institutes / universities / charities / funding bodies) who have, or may
claim to have co-ownership of the antibody, or who have contributed any funding, technology, material
used to generate the antibody, describing their contribution and any proposed revenue share with the 3rd
party institute or funding agency (the first line is an example line).
3rd Party institute      Contribution            Is Material (if         Notes
(host institute / co-                            relevant) Covered
owner IP)                                        by TTA?
e.g. MRC                 e.g. Primary Funder Not Applicable
e.g. UCL                 e.g. recombinant        e.g. No                 e.g. Revenue share and FTO will need to
                         ABC protein via                                 be assessed
                         MTA




5. List ALL commercial technologies that have contributed to the generation of this antibody, or are included
in the final product. (Completed by Investigator or CRT)
Commercial 3rd          Technology                      Notes
Party
e.g. Invitrogen         e.g Green FP


6. Location of Reagent: (Completed by Investigator)
Where is the hybridoma currently held (e.g. Investigator Lab)?




       Registered office: Sardinia House, Sardinia Street, London WC2A 3NL. Registered in England number
      1626049. VAT registration number GB788 138678. A wholly-owned subsidiary of Cancer Research UK,
                                           registered charity no. 1089464.