Content Editor



جامعة آل البيت

Al al- Bayt University

مركز الجودة و التطوير

Quality and Development Center

مركز التميز للابتكار وريادة الأعمال

Center of Excellence for Innovation and Entrepreneurship

Cent -EI- F006رقم النموذج
 Disclosure Form 

                             Please append any additional documentation that you consider relevant. You will be notified by the staff of the section of patent and Technology Transfer of their assessment of the invention and the strategy intends adopting to commercialise the invention.

1.Title of invention


2.  Type of Intellectual Property





Trade Marks

CopyrightIndustrial designs
Geographical indicationsTrade secrets


3.  Inventors: Please list all inventors


 InventorPositionInstitutional AffiliationPhone/ emailNationality





















4.  Contribution to the Invention


Each contributor/potential inventor should write a paragraph relating to his/her contribution and include a signature and date at the end of the paragraph. The summary should include whether the individual was for example involved in deciding on a general program me of work or designing particular experiments as well as whether he/she was involved in carrying out experimental work and the extent to which he/she was carrying out other peoples' instructions.


If there are more than five contributors, please affix additional pages.



Lead Inventor Contribution






Inventor 2 Contribution







Inventor 3 Contribution







Inventor 4 Contribution









Inventor 5 Contribution










5.  Description of Invention


National Research Priority Area    
AFuture Networks & CommunicationsH Food for Health
B Data Analytics, Management, Security & PrivacyI Sustainable Food Production and Processing
C Digital Platforms, Content & ApplicationsJ Marine Renewable Energy
D Connected Health and Independent LivingK Smart Grids & Smart Cities
E Medical DevicesL Manufacturing Competitiveness
F DiagnosticsM Processing Technologies and Novel Materials
G Therapeutics: Synthesis, Formulation, Processing and Drug DeliveryN Innovation in Services and Business Processes



General purpose of the invention and the problem it solves (short paragraph)
How it works (short paragraph here - please also attach a more complete document as an appendix giving a full technical description of the invention/design (this is to assist in the possible briefing of a patent agent) and include a sketch or sketches of the invention/design as appropriate
Utility: What does it do/could it do





Commercial applications





Advantages and improvements of this invention over existing methods/ materials/ devices/current state of the art (short paragraph)





Developmental stage of invention: e.g. idea, proven concept, prototype available (short paragraph)






6.Date of invention and public disclosure

Please include the following information

Date of invention and how this was documented (include Laboratory book details and reference no. where available)



Have any public disclosures been made?  If so, when, where and how (this can include oral communication, journal, abstract, poster, newsletter publication (online or print), thesis).

Accurate data is essential as prior disclosure may affect the possibility of obtaining patent rights



If planning any upcoming publication or disclosure, oral or written, of any aspect of the invention, please provide dates and details for public disclosures.



7.  Prior Art

Please include a short summary report of your prior art (patents and publications) search as an appendix to this DF. The report should list the closest related patents and publications. In the case of each item, please summarise that technology in a few lines and indicate why your invention is considered novel in comparison to that patent/paper.

Patent search tools you may wish to use include the following

  1. Espacenet(eurpean); (
  2. the US Patent office;
  4. Free patents online


8.  Sponsorship of research (if applicable)

Was the invention developed with funding from any public or private research grant/ contract?


If yes, please complete the following details. Please note accurate details are needed to fulfil UJIEC's obligations.

Project TitleProject TermSponsor (Funding Agency/Company name)





Are there any agreements in place relating to this invention, research collaboration agreements, Consultancy Agreements)?

If so, please outline



Please indicate below whether any aspect of the invention was made possible by the use of materials obtained from an outside individual and/or institution and/or company. Obligations to providers of these materials may exist.  List all materials and sources.

List all materials and sources.






9.    Please list any companies that you think may be active in this area/ interested in the invention. Please also indicate also whether you have any contacts in these companies.







10.     Enclosures:


The following documents are enclosed with the Invention Disclosure Form:
.      Pages describing the invention including       sketches / drawings
 Inventor's own work / publications in the field related to the invention
 Documents reflecting the prior art (publications, patent specifications, etc.)
 Copy / copies of third-party funded agreements / cooperative agreements



11.     Signatures and Approval


Inventors' Signatures

I/We acknowledge that I/We have read and understood this form andUA CEIE Intellectual Property and Technology Transfer Policy and have replied to the questions to the full extent of any knowledge available to me/us. 

I/We further agree to timely execute all assignments and other documents related to securing intellectual property protection and licensing of the invention and to otherwise cooperate with the Patent and Technology Transfer section and the patent attorney selected to handle this case. 

I/We also agree to make available to the UA CEIE, upon request, copies of lab notebooks and any other materials which contain information about the invention if applicable.


 Inventor NameInventor Signature%age contributionDate
Lead Inventor                    
Inventor 2                    
Inventor 3                    
Inventor 4                    
Inventor 5                    


UACEIE Acknowledgement and approval


I acknowledge that this patent disclosure form was presented Excellence for Innovation and Entrepreneurship canter on the date indicated below.


Name     SignatureDate
Patent and Technology Transfer Section………………………………………………………………………………….
Director of Excellence for Innovation and Entrepreneurship canter…………………………………………………………………………………..