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Research Management Centre UTM/RMC/F/0027

The document is an invention disclosure form from Universiti Teknologi Malaysia. It provides details about an invention for classifying EOG signals of eye movement potentials, including inventors, funding sources, dates, potential applications and commercial prospects.

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Norazimah Mat Zain
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72 views4 pages

Research Management Centre UTM/RMC/F/0027

The document is an invention disclosure form from Universiti Teknologi Malaysia. It provides details about an invention for classifying EOG signals of eye movement potentials, including inventors, funding sources, dates, potential applications and commercial prospects.

Uploaded by

Norazimah Mat Zain
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Research Management Centre

UTM/RMC/F/0027

UNIVERSITI TEKNOLOGI MALAYSIA Invention Disclosure This form contains disclosure of invention or copyrightable material and should be submitted in confidence to The Secretariat, Intellectual Property Committee, Research Management Centre (RMC), Universiti Teknologi Malaysia, 81310 UTM Skudai. 1. Type of Material : Invention /// Copyright /

2. Title of Invention or Copyright : Classification of EOG Signals of Eye Movement Potentials 3. Inventor(s) 3.1 Principal 3.2 Associates Full Name Department/Institute/ Centre/Unit Approximate % Contribution

Rubita Sudirman / Department of Electronics, Universiti Teknologi Malaysia Wan Mohd Bukhari Bin Wan Daud / Department of Electronics

3.3 Others 4. Identify sources and estimate % of support (materials, facilities, salaries) contributing to the development of the invention : Government Funds ( IRPA, grants and /or contract) UTM-RMC Funds Other Institution (s) : Name : Other source : 5. If developed with Government Funds : Has invention been reported to granting agency ? Agency Name : Grant Number : Has notification been made to the relevant Government Agency for retention of rights to invention ? Yes No Please attach copies of any correspondence with any Government agency related to disclosure of invention or rights to invention. 6. If developed with other funds (industry sponsor, foundation grant ,etc.) : Has the invention been reported to the sponsor? Yes No Yes Report Date: No % % % %

Source name : Report Date : Please attach copies of relevant correspondence with the sponsor. 7. Record of Invention :
UTM Invention Disclosure Page 1 of 3

Research Management Centre

UTM/RMC/F/0027

7.1 Invention was first conceived on or about (Date) : 7.2 An oral disclosure has been made : (Name) (Name) 7.3 First sketch or drawing was made on (Date) : understood by (Name ) : That document is now located at: 7.4 First written description was completed on (Date) : document is now located at : /

/ on (Date) on (Date) / / / / /

disclosed to and / /

on (Date) :

and that

7.5 First reduction to practice was successfully tested on (Date) : the records of that test are now located at 7.6 First publication disclosing the invention was dated (Date ) : /

and

8. List companies or individuals with whom you may have discussed this project and append copies, showing dates, of all correspondence relating to their interest. (Name) (Name) (Correspondence Date) : (Correspondence Date) : / / / /

If you have communicated, via telephone, with any additional companies, please list the company names, giving dates, and append a brief summary of your conversations. (Name) Summary of conversation: (Communication Date ) : / /

(Note : Valuable rights to inventions may be lost if disclosed to outside parties unless signed Confidentiality Agreement is obtained) 9. Has invention or components thereof been described in a draft of an article or lecture ? If so, please attach copies of drafts of abstracts, manuscripts, or reprints and give proposed presentation and/or publication dates. (Type & Title of Draft) : (Proposed Presentation Date) : / / (Note : Premature disclosure of invention in lectures, articles, etc. may result in loss of all right to obtain patent) 10. Briefly outline your views regarding potential commercial application of your invention : 10.1List potential licencees or manufacturers or companies active in this field. Name : Name : Name : 10.2What is potential market ?
UTM Invention Disclosure Page 2 of 3

Research Management Centre

UTM/RMC/F/0027

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 10.3Estimate commercial market in RM and USD : RM _______ USD _______

11. List independent referees with expertise in the area of the invention with whom we may communicate for additional information (with your approval) : (Name, address, contact nos. ) : _______________________________________________ (Name, address, contact nos.) : _______________________________________________ 12. Please append a full description of the invention which should include the following : 12.1 Drawings, diagrams, figures, flowcharts, sketches etc. which illustrate the invention. 12.2 Chemical structural form (if the invention is a new chemical compound). 12.3 List of equivalents which can be substituted for the invention or for components of the invention. 12.4 Reprints of articles or patents describing inventions, methods etc. similar to the one described in this disclosure. 12.5 Describe why your product or process is sufficiently novel compared to those already available to warrant patentability.

Principal Inventor : __________________ (Signature) Name : Address :

Dean/Director : ______________________ of Faculty/Centre/Institute (Signature) Name : Address :

Telephone / Fax : Date : ____ / ____ / ____

Telephone / Fax : Date : ____ / ____ / ____

UNIVERSITI TEKNOLOGI MALAYSIA RETAINS TITLE TO ALL INVENTIONS AND PATENTS AS PROVIDED FOR IN THE INTELLECTUAL PROPERTY POLICY. If you have any enquiry about this set of forms, or intellectual property protection in general, please contact Deputy Director (IP Secretariat), Research Management Centre, UTM 81310 Skudai at 07-5537804 or e-mail [email protected].

UTM Invention Disclosure

Page 3 of 3

INVENTION DISCLOSURE

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