��ࡱ� > �� H J ���� G �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� � �� � bjbj>> n= pT pT s 7 �� �� �� � � � $ ���� D D D P � � � D � � < < < < < � � � B D D D D D D $ � � m d h � ` ` | � � h < < $ } � X < < B � B < ���� P0�gI�� ���� 4 F . � 0 � � z � � � � � � � � � � h h � � � � � � � � ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� � � � � � � � � � � � � : Report of an invention pursuant to section�4 of the Public Servants Inventions Act and section�2 of the Public Servants Inventions Regulations
Information to be furnished by Public Servant inventor
1Name(s) of the inventor(s). (Please complete in full: Surname, Given Name, any initials)
2Address(es): Residence
3Nationality of inventor(s)
4Department or Government Agency in which you are employed
5Position(s) and type of work
6Your proposed name or title for the invention
7Brief description, and drawings, where necessary, of your invention under the following headings: (May be in the form of an Appendix):
(a) What is the problem?
(b) How may it be accomplished according to the present knowledge?
(c) Limitations or drawbacks of present apparatus, product or process.
(d) What is your proposal?
(e) What is thought to be novel in your proposal?
8Has any publication or disclosure to other been made? If so to whom, when and where and by what mode?
9Can you provide references in published literature or patents relating to the problem or subject? If yes, do so.
10Describe the circumstances surrounding the making of the invention. Did the invention result from or was it connected with your duties or employment? Was it made with facilities, equipment or financial aid provided by or on behalf of the Crown?
Place Date
Signature
NOTE: Where spaces are inadequate, attach separate pages.
Information to be furnished by immediate supervisor or other appropriate departmental officer
1Did the invention arise from a general programme of research or from work in relation to a particular piece of equipment, process or problem? If yes, give details.
2Does a development contract exist in relation to the invention or is one projected?
3Have other persons or organizations participated in the development? If yes, indicate assistance provided and by whom.
4Has the apparatus, product or process been made or tested?
5In your opinion what are the possible commercial applications of the invention and their extent?
6What are the actual or potential uses of the invention by the Armed Forces or other government agencies?
7Comments, if any, on inventor's answers.
8Other remarks including security classification.
Place Date
________________________
Print Name
_________________________
Print Title
__________________________
Phone number and email address
____________________________
Signature
NOTE: Where spaces are inadequate, attach separate pages.
FORM 1
PART 1
FORM 1
PART 2
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