Disclosure Number: ________

Name: ______________________________________________ Date: ____________________

One sentence description of novelty:

_______________________________________________________________________________

_______________________________________________________________________________

Aspects of Invention:

apparatus method of use method of manufacture software

Which products is invention applicable to: ___________________________________________

What elements are not provided by company:__________________________________________

Are all elements sold together: _____________________________________________________

Have design around options been considered? yes no

Closest known prior art ___________________________________________________________

Related to other patents no yes, _____________________________________________

previously disclosed planned disclosure, disclosure date __________________________

Value Analysis

Invention will: enable new product provide addl. revenue from existing product enhance existing product provides additional barrier to entry

Does invention align with core business objectives? yes no

Technology will be applicable for 5 10 15 >20 years

Does invention provide licensing opportunities in other industries? yes no

If yes, which industries: _______________________________________________

Decision

perform search and report to committee perform search and file based on novelty

judgment file without search do not file defensive publication

Countries to file in: _______________________________________________________________

_______________________________________________________________________________

Comments:

_______________________________________________________________________________