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INVENTION DISCLOSURE FORM

[ORGANIZATION NAME]

CONFIDENTIAL - ATTORNEY-CLIENT PRIVILEGED

This document may be protected by attorney-client privilege and/or work product doctrine. Do not distribute without authorization from the Legal Department.

SECTION A: ADMINISTRATIVE INFORMATION

Field	Information
Disclosure Number:	IDF-______-______ (To be assigned by IP Department)
Date Submitted:	_________________________________
Department/Division:	_________________________________
Business Unit:	_________________________________
Submitted By:	_________________________________
Contact Email:	_________________________________
Contact Phone:	_________________________________

SECTION B: INVENTION TITLE AND SUMMARY

B.1 Invention Title

Provide a brief, descriptive title for the invention:

_________________________________________________________________________________

B.2 Executive Summary

Provide a brief (2-3 sentence) non-technical summary of the invention:

B.3 Technical Field

Identify the technical field(s) to which the invention relates:

☐ Software/Computing
☐ Electrical/Electronics
☐ Mechanical
☐ Chemical/Materials
☐ Biotechnology/Life Sciences
☐ Medical Devices
☐ Manufacturing/Process
☐ Data Analytics/AI/ML
☐ Communications/Networking
☐ Other: _______________________

SECTION C: INVENTOR INFORMATION

C.1 Primary Inventor (Person Submitting This Form)

Field	Information
Full Legal Name:	_________________________________
Employee ID:	_________________________________
Job Title:	_________________________________
Department:	_________________________________
Work Address:	_________________________________
Work Email:	_________________________________
Work Phone:	_________________________________
Home Address:	_________________________________
Citizenship:	_________________________________
Permanent Resident Country:	_________________________________

C.2 Joint Inventors

List ALL individuals who contributed to the conception of the invention. An inventor is anyone who contributed to the conception of at least one claimed feature of the invention.

Inventor 2:

Field	Information
Full Legal Name:	_________________________________
Employer:	☐ [Organization Name] ☐ Other: _____________
Employee ID (if applicable):	_________________________________
Job Title:	_________________________________
Work Email:	_________________________________
Contribution to Invention:	_________________________________
Citizenship:	_________________________________

Inventor 3:

Field	Information
Full Legal Name:	_________________________________
Employer:	☐ [Organization Name] ☐ Other: _____________
Employee ID (if applicable):	_________________________________
Job Title:	_________________________________
Work Email:	_________________________________
Contribution to Invention:	_________________________________
Citizenship:	_________________________________

☐ Additional inventors are listed on Attachment ___

C.3 Non-Employee Contributors

Were any non-employees involved in the conception or development of this invention?

☐ No non-employees contributed to this invention

☐ Yes - Provide details:

Name	Organization	Role/Contribution	Agreement in Place
			☐ NDA ☐ JDA ☐ Consulting ☐ None
			☐ NDA ☐ JDA ☐ Consulting ☐ None

SECTION D: DETAILED DESCRIPTION OF THE INVENTION

D.1 Problem Statement

What problem does the invention solve? What need does it address?

D.2 Prior Solutions (State of the Art)

Describe existing solutions to the problem and their limitations:

D.3 Detailed Technical Description

Provide a complete technical description of the invention. Include:
- How the invention works
- Key components, steps, or elements
- How it differs from prior solutions
- Alternative embodiments or variations

(Attach additional pages, diagrams, flowcharts, or drawings as needed)

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

D.4 Novel Features

List the specific features you believe are new and inventive:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

D.5 Advantages and Benefits

What are the advantages of the invention over existing solutions?

☐ Improved performance: _______________________________________________________
☐ Lower cost: _________________________________________________________________
☐ Smaller size/weight: _________________________________________________________
☐ Faster speed: _______________________________________________________________
☐ Better reliability: ___________________________________________________________
☐ Easier to use: ______________________________________________________________
☐ Other: _____________________________________________________________________

SECTION E: DEVELOPMENT HISTORY AND DATES

E.1 Key Dates

IMPORTANT: These dates are critical for determining patent rights. Please be as accurate as possible and provide supporting documentation.

Event	Date	Documentation
Date of initial conception (when the idea was first formed)	_____________	☐ Attached
Date reduced to practice (when a working embodiment was created/tested)	_____________	☐ Attached
Date of first successful test/demonstration	_____________	☐ Attached
Date invention was first documented in writing	_____________	☐ Attached

E.2 Documentation

What documentation exists for this invention?

☐ Lab notebooks (Dates: _______________)
☐ Design documents (Dates: _______________)
☐ Technical specifications (Dates: _______________)
☐ Email correspondence (Dates: _______________)
☐ Presentation slides (Dates: _______________)
☐ Prototypes/samples (Dates: _______________)
☐ Test results (Dates: _______________)
☐ Source code (Dates: _______________)
☐ Other: ___________________________________

SECTION F: DISCLOSURES AND PUBLIC ACTIVITIES

F.1 Public Disclosures

CRITICAL: Under U.S. patent law, you have one year from the first public disclosure to file a patent application. Many foreign countries have no grace period - any disclosure before filing may prevent patent protection.

Has the invention been disclosed to anyone outside [Organization Name]?

☐ No - The invention has not been disclosed to any non-employees

☐ Yes - Provide details for EACH disclosure:

Date	Recipient(s)	Method	NDA in Place	Details
		☐ Verbal ☐ Written ☐ Demo	☐ Yes ☐ No
		☐ Verbal ☐ Written ☐ Demo	☐ Yes ☐ No

F.2 Publications

Has the invention been described in any publication?

☐ No

☐ Yes - Provide details:

Publication	Date	Author(s)	Status
			☐ Published ☐ Submitted ☐ Planned
			☐ Published ☐ Submitted ☐ Planned

F.3 Presentations and Conferences

Has the invention been presented at any conference, trade show, or meeting?

☐ No

☐ Yes - Provide details:

Event	Date	Location	Audience	Public
				☐ Yes ☐ No
				☐ Yes ☐ No

F.4 Planned Disclosures

Are there any planned publications, presentations, or product launches that may disclose the invention?

☐ No

☐ Yes - Provide details:

Activity	Planned Date	Can Date Be Delayed?
		☐ Yes ☐ No
		☐ Yes ☐ No

SECTION G: COMMERCIAL AND BUSINESS INFORMATION

G.1 Products and Services

Is the invention currently being used or planned for use in any product or service?

☐ Currently in use in: _______________________________________________________
☐ Planned for use in: _______________________________________________________ (Expected date: _________)
☐ No current plans for commercial use

G.2 Market and Business Value

Describe the potential commercial value of the invention:

Market size/opportunity: ____________________________________________________
Revenue potential: _________________________________________________________
Competitive advantage: _____________________________________________________
Customer value: ____________________________________________________________

G.3 Competitive Landscape

Who are the potential competitors in this space?

Competitor	Their Approach	Our Advantage

G.4 Alternative Technologies

Are there alternative technologies or methods that could achieve similar results?

☐ No known alternatives
☐ Yes - Describe:

_________________________________________________________________________________
_________________________________________________________________________________

SECTION H: PRIOR ART AND RELATED TECHNOLOGIES

H.1 Known Prior Art

List any patents, publications, products, or other prior art that you are aware of that may be related to this invention:

Patents/Patent Applications:

Patent/Application No.	Title	Relevance

Publications/Articles:

Title	Author(s)	Date	Publication

Commercial Products:

Product	Manufacturer	Relevance

H.2 Searches Conducted

Have you conducted any prior art searches?

☐ No
☐ Yes - Describe search conducted and attach results:

_________________________________________________________________________________
_________________________________________________________________________________

SECTION I: FUNDING AND OBLIGATIONS

I.1 Government Funding

Was any portion of this invention developed with U.S. government funding?

☐ No

☐ Yes - Provide details:

Agency	Contract/Grant No.	Program	Funding Period

Note: Inventions developed with government funding may be subject to the Bayh-Dole Act (35 U.S.C. Sections 200-212), which requires disclosure to the funding agency and may provide the government with certain rights.

I.2 Third-Party Funding or Collaboration

Was any portion of this invention developed under a sponsored research agreement, joint development agreement, or collaboration with a third party?

☐ No

☐ Yes - Provide details:

Third Party	Agreement Type	IP Provisions

I.3 Third-Party Materials or Technology

Were any third-party materials, tools, or technologies used in developing this invention?

☐ No

☐ Yes - Provide details:

Item	Provider	License Terms

SECTION J: ATTACHMENTS

Please attach the following materials (as applicable):

☐ Technical drawings, diagrams, or flowcharts
☐ Photographs of prototypes or implementations
☐ Test data and results
☐ Prior art documents
☐ Relevant correspondence
☐ Lab notebook pages
☐ Source code samples
☐ Product specifications
☐ Additional inventor information
☐ Other: _______________________

List of Attachments:

Attachment #	Description	Pages/Files
1
2
3

SECTION K: INVENTOR DECLARATION

I/We, the undersigned inventor(s), hereby declare that:

The information provided in this Invention Disclosure Form is true and complete to the best of my/our knowledge.
I/We have disclosed all material information relevant to the patentability of this invention, including all prior art of which I/we am/are aware.
I/We have disclosed all public disclosures, publications, and commercial activities related to this invention.
I/We have disclosed all funding sources and third-party obligations that may affect ownership or rights to this invention.
I/We acknowledge my/our obligation under my/our employment agreement to assign inventions developed within the scope of employment to [Organization Name].
I/We agree to cooperate in the preparation and prosecution of any patent application that may be filed based on this invention, including signing all necessary documents and providing additional information as requested.
I/We understand that this disclosure is confidential and should not be shared outside the organization without proper authorization.

INVENTOR SIGNATURES

Primary Inventor:

Signature: _________________________________

Printed Name: _____________________________

Date: ____________________________________

Inventor 2:

Signature: _________________________________

Printed Name: _____________________________

Date: ____________________________________

Inventor 3:

Signature: _________________________________

Printed Name: _____________________________

Date: ____________________________________

SECTION L: INTERNAL USE ONLY

L.1 Receipt and Review

Field	Information
Date Received by IP Department:	_________________
Received By:	_________________
Disclosure Number Assigned:	IDF-______-______
Initial Review Completed:	_________________

L.2 Evaluation

Criterion	Assessment	Notes
Novelty	☐ High ☐ Medium ☐ Low
Non-obviousness	☐ High ☐ Medium ☐ Low
Commercial value	☐ High ☐ Medium ☐ Low
Strategic importance	☐ High ☐ Medium ☐ Low
Competitive threat	☐ High ☐ Medium ☐ Low
Filing urgency	☐ High ☐ Medium ☐ Low

L.3 Decision

☐ File patent application - Priority: ☐ High ☐ Medium ☐ Low
- Filing strategy: ☐ Provisional ☐ Non-provisional ☐ PCT
- Countries: ________________________________________________

☐ Conduct additional prior art search

☐ Request additional information from inventor(s)

☐ Defer decision - Review date: _________________

☐ Do not pursue patent protection - Reason: _________________

☐ Maintain as trade secret

L.4 Approvals

Role	Name	Signature	Date
IP Manager
Business Unit Lead
Legal Counsel

L.5 Action Items

Action	Responsible	Due Date	Status
			☐ Open ☐ Complete
			☐ Open ☐ Complete
			☐ Open ☐ Complete

NOTICE: This form is provided for informational purposes only and does not constitute legal advice. Patent rights depend on many factors including timing of disclosures and filings. Consult with a qualified patent attorney regarding specific patentability questions and filing strategies.

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INVENTION DISCLOSURE FORM

CONFIDENTIAL - ATTORNEY-CLIENT PRIVILEGED

SECTION A: ADMINISTRATIVE INFORMATION

SECTION B: INVENTION TITLE AND SUMMARY

B.1 Invention Title

B.2 Executive Summary

B.3 Technical Field

SECTION C: INVENTOR INFORMATION

C.1 Primary Inventor (Person Submitting This Form)

C.2 Joint Inventors

C.3 Non-Employee Contributors

SECTION D: DETAILED DESCRIPTION OF THE INVENTION

D.1 Problem Statement

D.2 Prior Solutions (State of the Art)

D.3 Detailed Technical Description

D.4 Novel Features

D.5 Advantages and Benefits

SECTION E: DEVELOPMENT HISTORY AND DATES

E.1 Key Dates

E.2 Documentation

SECTION F: DISCLOSURES AND PUBLIC ACTIVITIES

F.1 Public Disclosures

F.2 Publications

F.3 Presentations and Conferences

F.4 Planned Disclosures

SECTION G: COMMERCIAL AND BUSINESS INFORMATION

G.1 Products and Services

G.2 Market and Business Value

G.3 Competitive Landscape

G.4 Alternative Technologies

SECTION H: PRIOR ART AND RELATED TECHNOLOGIES

H.1 Known Prior Art

H.2 Searches Conducted

SECTION I: FUNDING AND OBLIGATIONS

I.1 Government Funding

I.2 Third-Party Funding or Collaboration

I.3 Third-Party Materials or Technology

SECTION J: ATTACHMENTS

SECTION K: INVENTOR DECLARATION

INVENTOR SIGNATURES

SECTION L: INTERNAL USE ONLY

L.1 Receipt and Review

L.2 Evaluation

L.3 Decision

L.4 Approvals

L.5 Action Items

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