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Grant ( EI/ATRP, FP5 etc.): Grant Identification No: Title: Grant Holder: Dept.: Amount: Duration: Start date: DECLARATIONS EXISTING RELEVANT PATENTS Please give name of any related patents along with inventor(s) name(s), filing date and status: …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… OTHER RELATED GRANTS Grant Body Date Project Title IP Obligations Status File ref ………….. …… ………………………………………… ……………… …….. ………. ………….. …… ………………………………………… ……………… …….. ………. ………….. …… ………………………………………… ……………… …….. ………. ………….. …… ………………………………………… ……………… …….. ………. RELEVANT INDUSTRIAL CONTACTS Please list all relevant existing and pending contacts with industry in respect of any work/technology related to the field this current research grant and which may impinge on the research, its exploitation or the obligations under this research grant. Please document any obligations, implicit or binding such as CDAs, MTAs options etc. Company Nature of contact Date Status …………….. ……………………………………………………. ……… …………… …………….. ……………………………………………………. ……… …………… …………….. ……………………………………………………. ……… …………… …………….. ……………………………………………………. ……… …………… PRE-EXISTING KNOW HOW AND PUBLICATIONS Please document any relevant publications or other pre-existing know how not covered in the foregoing …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… OTHER RELEVANT INFORMATION Please document other relevant research or commercialisition activity ( prospective or otherwise) in related fields including licence/option discussions, spin-out company activity etc. …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… CONFLICTS OF INTEREST Please document any real or potential conflicts of interest of researchers engaged on the project. …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… I declare that to the best of my knowledge, the above information is correct and complete. I have read and understand the terms of the contract named above and agree to be bound by its terms and to exercise due diligence in its implementation and management. Signed:……………………………………. Name( PRINT)……………………………………. Project Supervisor Date:………………………………………. Research Grant IP and Due Diligence Form Supplementary Researcher Form To be completed in respect of all researchers involved in the project and or inventors contributing to the IP. Project Title: Grant Body: Contract no: Contract date: Being a researcher in the above named project I agree to assign to UCC/ National University of Ireland Cork, all Intellectual Property developed by me which is related to the research field of the project. Signed:……………………………………. Name( PRINT)……………………………………. Date:………………………………………. Signed:……………………………………. Name( PRINT)……………………………………. Date:………………………………………. Signed:……………………………………. Name( PRINT)……………………………………. Date:………………………………………. Signed:……………………………………. Name( PRINT)……………………………………. Date:………………………………………. 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