ITMC Form

ANNEXURE-1
The Director,
National Dairy Research Institute,
(A Constituent of ICAR),
Karnal-132001, Haryana.
Sub: Undertaking and Declaration in regard to Invention made by the undersigned
In regards to the invention made by us, we have requested our director to forward the proposal
for filing application for patent. In this connection we reiterate the following facts.
1. Title of the Invention:
The invention made by us is completely new and is on account of inventive steps taken by us, it
has not been published.
i. There is no lawful ground of objection to the grant of patent in respect of our
invention.
ii. We have perused the available literature on the subject and we confirm that no
invention has been made by any person of the type mentioned as item no. (i)
Above.
iii. We undertake to keep you poste of developments in regard to
correspondence/business discussion if any, pertaining to the above mentioned
invention, in future.
iv. We give below the declaration for assignment of rights to ICAR.
In view of the above facts, we request you to kindly expedite the filing of the application.
Yours faithfully
Name(s) of the Inventor(s) (Signature)
1. -------------------------------------
-
2. -------------------------------------
-
3. -------------------------------------
-
ANNEXURE-2
DECLARATION BY INVENTOR(S)
We declare that the authorized official of ICAR, who has signed the application for the invention
under reference as applicant is our assignee.
Date:
INVENTOR(S)
NAME (in full with expanded initials) SIGNATURE
1. ------------------------------
2. ------------------------------
3. ------------------------------
Signature of two witnesses along with their names and addresses.
NAME DESIGNATION SIGNATURE

FORM 1 (FOR OFFICE USE ONLY)
THE PATENTS ACT, 1970
(39 of 1970) Application No:
& Filing Date:
The Patents Rules, 2003 Amount of Fee Paid:
APPLICATION FOR GRANT OF PATENT CBR No:
(See sections 7, 54 & 135 and rule 20(1)) Signature:
1. APPLICANT(S)
Name Nationality Address
Indian Council of Agricultural Krishi Bhavan, Dr. Rajendra
Research (ICAR) An Indian Prasad Road, New Delhi-110001,
autonomous India
organization
2. INVENTOR(S)
Name Nationality Address
3. TITLE OF THE INVENTION

“ --------------------------------------------------------------------------------------------”
4. ADDRESS FOR CORRESPONDENCE OF APPLICANT/ AUTHORISED
PATENT AGENT IN INDIA
Telephone No.
Mobile No.
E-mail:
5. PRIORITY PARTICULARS OF THE APPLICATION (S) FILED IN
CONVENTION COUNTRY -
Application Name of the Title of the
Country Filing date
number Applicant invention
6. PARTICULARS FOR FILING PATENT COOPERATION TREATY (PCT) NATIONAL PHASE
APPLICATION -
International Application International filing date as allotted by the receiving
Number office
7. PARTICULARS FOR FILING DIVISIONAL APPLICATION -

Original (first) application
Date of filing of Original (first) application
number
8. PATICULARS FOR FILING PATENT OF ADDITION

Main application / Patent Number Date of filing of main application
9. DECLARATIONS:
(i) Declaration by the inventor(s)
I/We, the above named inventor(s) is/ are the true & first inventor(s) for this invention
and declare that the applicant(s) herein is /are my/our assignee or legal representative.
(a)Date: …. /…../20….
(b)Signature(s)
(Suresh Kumar M.S) (Ahamed Thouseeth.P) (Arjun C.R.M) (Aswatth Krishna.S)

(ii) Declaration by the applicant(s) in the convention country
I/We, the applicant(s) in the convention country declare that the applicant(s) herein
is/are my/our assignee or legal representative.
(a) Date: …. /…../20….

(b) Signature(s)
(c) Name(s) of the signatory
(iii) Declaration by the applicant(s):
I/We, the applicant(s) hereby declare(s) that:-
I am / We are in possession of the above-mentioned invention.
The provisional/complete specification relating to the invention is filed with this
application.
The invention as disclosed in the specification uses the biological material from
India and the necessary permission from competent authority shall be submitted
by me/us before the grant of patent to me/ us.
There is no lawful ground of objection to the grant of patent to me/ us.
I am/We are the assignee or legal representative of true and first inventors.
The application or each of the applications, particulars of which are given in para
5 was the first application in convention country/ countries in respect of my/ our
invention
I/We claim the priority from the above-mentioned application(s) filed in
convention country/countries and state that no application for protection in
respect of the invention had been made in a convention country before that date
by me/us or by any person from which I/We derive the title.
My/Our application in India is based on international application under Patent
Cooperation Treaty (PCT) as mentioned in Para 6.
The application is divided out of my/ our application particulars of which are
given in para 7 and pray this application may be treated as deemed to have been
filed on _________ under section 16 of the Act.
The said invention is an improvement or modification of the invention particulars
of which are given in Para 8.
10. FOLLOWING ARE THE ATTACHMENTS WITH THE APPLICATION
(a)Provisional specification/ complete specification

(b)Complete specification (in conformation with the international application)/
as amended before the International Preliminary Examination Authority
(IPEA), as applicable (2 copies), No. of pages ------ No. of claim -----
(c)Drawings (in conformation with the international application)/ as amended
before the International Preliminary Examination Authority (IPEA), as
applicable (2 copies), No. of sheets -------
(d)Priority documents
(e)Translation of priority document/Specification/International Search Report
(f)Statement and undertaking on Form 3
(g)Power of authority
(h)Declaration of inventorship on Form5
(i)Sequence listing in electronic form
Fee Rs. -------------in Cash/ Cheque/ Bank Draft bearing no…………..

Date……………on……………..Bank.
I/We hereby declare that to the best of my/our knowledge, information and belief the
fact and matters stated herein are correct and I/We request that a patent may be
granted to me/ us for the said invention.
Dated this …………………. day of………………20…….
Signature:
Name
To,
The controller of Patents,
The patent office, at …………….
Note:- *Repeat boxes in case of more than one entry.
*To be signed by the applicant(s) or by authorized registered patent agent otherwise
where mentioned.
*Tick (√ )/cross (x) whichever is applicable/not applicable in declaration in para-9.
*Name of the inventor and applicant should be given in full, family name in the
beginning.
*Complete address of the inventor and applicant should be given stating the postal
index no./code, state and country.
*Strike out the column(s) which is/are not applicable.
*For fee: See First Schedule.
FORM 5
THE PATENTS ACT, 1970 (39 of 1970)
&
THE PATENTS RULES, 2003
DECLARATION AS TO INVENTORSHIP
(See section 8, rule 12)
1. NAME OF APPLICANT(S) Indian Council of Agricultural Research
hereby declare that the true and first inventor(s) of the invention disclosed in the
complete specification filed in pursuance of my/our application numbered
____________ dated __________________ is/are
2. INVENTOR(S)
1)
(a) NAME :
(b) NATIONALITY :
(c) ADDRESS :
2)
(a) NAME :
(b) NATIONALITY :
(c) ADDRESS :
3)
(a) NAME :
(b) NATIONALITY :
(c) ADDRESS :
Dated this ………day of ……………………..20……
Signature:
Name of the signatory: (Director, N.D.R.I (ICAR), Karnal, Haryana-132001)

4) Declaration to be given when the application in India is filed by the
Applicant(s) in the convention country: -
We the applicant(s) in the convention country hereby declare that our right to apply
for a patent in India is by way or assignment from the true and first inventor(s).
Dated this ……..day of ……………..20……

Signature:-
Name of the signatory:-
5) STATEMENT (to be signed by the additional inventor(s) not mentioned in
the application form) Not applicable
I/We assent to the invention referred to in the above declaration, being included in
the complete specification filed in pursuance of the stated application.
Dated this ………..day of ………………..20…….
Signature of the additional inventor(s): -

Name: -
To,
The Controller of Patents
The Patent Office, New Delhi
Note:-
*Repeat boxes in case of more than one entry.
*To be signed by the applicant(s) or by authorized registered patent agent otherwise where
mentioned.
*Name of the inventor and applicant should be given in full, family name in the beginning.
*Complete address of the inventor should be given stating the postal index no./ code, state and
country.
* Strike out the column(s) which is/are not applicable.

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ANNEXURE-1

Sub: Undertaking and Declaration in regard to Invention made by the undersigned

1. Title of the Invention:

Name(s) of the Inventor(s) (Signature)

NAME (in full with expanded initials) SIGNATURE

Signature of two witnesses along with their names and addresses.

NAME DESIGNATION SIGNATURE

3. TITLE OF THE INVENTION

7. PARTICULARS FOR FILING DIVISIONAL APPLICATION -

8. PATICULARS FOR FILING PATENT OF ADDITION

(Suresh Kumar M.S) (Ahamed Thouseeth.P) (Arjun C.R.M) (Aswatth Krishna.S)

(a) Date: …. /…../20….

10. FOLLOWING ARE THE ATTACHMENTS WITH THE APPLICATION

(a)Provisional specification/ complete specification

Fee Rs. -------------in Cash/ Cheque/ Bank Draft bearing no…………..

Dated this …………………. day of………………20…….

Dated this ………day of ……………………..20……

Name of the signatory: (Director, N.D.R.I (ICAR), Karnal, Haryana-132001)

Dated this ……..day of ……………..20……

Dated this ………..day of ………………..20…….

Signature of the additional inventor(s): -

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