Intellectual Property Disclosure Form
(CONFIDENTIAL -- Not for Public Disclosure)

Disclosure No. Dept Code/Project Code/______________

Note: Intellectual Property Disclosure is treated as confidential information. Except for individuals engaged in the evaluation and approval process, the information will not be divulged to others without the permission of the creator/s

This Intellectual Property Disclosure form is developed by the IPR Cell of NID. As per the intellectual property norms, work created by anyone at NID has an obligation to disclose the creative work, which has potential and is worth protecting. Filling up this form and submitting it to the IPR Cell may fulfill part of this obligation.

1. TITLE OF WORK

2. TYPE OF WORK

Tick mark the suitable category under which your work falls:

1.   Complete Product
2.   Product Detailing
3.   Hardware
4.   Non functional Object/Artifact
5.   Method (of production/making)
6.   Furniture
7.   Furniture detailing
8.   Logo
9.   Symbol
10. Photographs
11. Graphic Layout
12. Typeface
13. Patterns
14. Film
15. Animation style
16. Animation Character
17. Any others (Describe)

3. LIST OF CREATOR/S (Designers, Contributors, Authors, Others)

Name:
Position;
Department:
E-mail Address:
Extension No.:

4. ATTACHMENTS

Tick mark what you have attached

1. Detailed description of your work
2. Design Drawings
3. Photographs
4. Artwork
5. Any other (Please indicate)
5. SOURCES (of derivation of data or literature sources)

6. HAS THE INTELLECTUAL PROPERTY BEEN DISCLOSED TO INDUSTRIAL REPRESENTATIVES?

YES/NO

(If yes provide information)

7. HAS THIS CREATIVE WORK BEEN DISCLOSED IN AN ABSTRACT, PAPER, PRESENTATION, EXHIBITION OR DISPLAY, TALK/SEMINAR, NEWS STORY OR IN ANY OTHER WAY

YES/NO

(If yes provide information)

Signature/s of creators Date ________________

1. _____________
2. _____________
3. _____________

If you have any questions or queries about this form or Intellectual Properties please contact the IPR Cell.