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DISCLOSURE OF INVENTION FORM FOR PREPARING A PATENT APPLICATION by osq14347

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									                           DISCLOSURE OF INVENTION FORM
                                        FOR
                          PREPARING A PATENT APPLICATION


                                 GENERAL DATA



1.   Title of invention:         ________________________________________________
     (Use technical terms and
     not proposed trademarks)    ________________________________________________


2.   Name of Inventor:           ________________________________________________

            Address:             ________________________________________________

            Phone:               ________________________________________________


3.   Citizenship:                ________________________________________________
                                                     Country


4.   Name, address and
     citizenship of any          ________________________________________________
     coinventors:                Name
                                 ________________________________________________
                                 Address
                                 ________________________________________________
                                 Country of Citizenship

                                 ________________________________________________
                                 Name
                                 ________________________________________________
                                 Address
                                 ________________________________________________
                                 Country of Citizenship




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5.    Is the patent to be assigned to an individual or a corporation? If so, give full name and
      address and if a corporation, give state of incorporation.

                                     ________________________________________________
                                     Full Name of Individual or Corporation
                                     ________________________________________________
                                     Address
                                     ________________________________________________
                                     State of Incorporation


6.    Date invention was first
      disclosed to others:           ________________________________________________
                                     Date


7.    State whether the invention has been reduced to practice (made and tested). If so, give
      the dates it was made and tested.

                                     ________________________________________________
                                     Date Completed (Made)
                                     ________________________________________________
                                     Date Tested


8.    State whether the invention was ever used for profit; published (such as in a scientific
      journal, news story, etc.) or offered for sale. If any of these, indicate which one and the
      date it first occurred.

                                     ________________________________________________
                                     Date


9.    State whether any sale, use for profit or printed publication is contemplated in the next
      six months and attach any copies of any existing manuscripts or abstracts.

                                     ________________________________________________

                                     ________________________________________________


10.   State whether any application has been previously made by you in any country:

                                     ________________________________________________
                                     Country
                                     ________________________________________________
                                     Date Filed


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