U.P. Technology Transfer and Business Development Office |

COPYRIGHT DISCLOSURE FORM

The author/s is/are requested to fill in the CIF so that the University offices concerned will be able to give a sound assessment on matters relating to ownership, rights and obligations of the author/s. Apportionment of Rights Based on Authorship Rights over the work should be established if it is the product of the joint efforts of several authors. By filling in this form, the author/s agree that the same constitutes their agreement regarding the apportionment of authorship and related rights such as copyright and royalties. However, this CIF is not binding on the University, as it needs to determine the validity based on existing policies and contracts Source of Funds and Use of Facilities and EquipmentThe source of funds and the substantial use of University facilities as well as those of other government and private entities that led to the creation of the work are basic information that need to be established to ascertain whether the author/s has/have the duty to assign intellectual property Disclosure For University-funded works, kindly submit a copy of document evidencing completion and submission of work to the University. Publication Details must be indicated and all other relevant documents must be attached to this form. If the author/s plan to submit the work for publication, kindly attach the following:
1. Publication by an international journal - background information and editorial policies
2. Publication by a private entity - proposed contract between the author/s and publisher
In case of University-funded work, kindly indicate whether the work to be published is the very same work for which funding was provided. In the event the above titled work is published and the publication sufficiently discloses a product or process that may be the subject of a patent application, the inventor has only a period of twelve (12) months from such disclosure under Philippine law to file a patent application. If you have questions or if you would like assistance in filling out the form, please call the TTBDO at tel. nos.: 9818500 local 2542 or e-mail [email protected] Kindly return the original Copyright Information Form together with any supporting documents to: TECHNOLOGY TRANSFER AND BUSINESS DEVELOPMENT OFFICE G/F National Institute of Molecular Biology and Biotechnology, College of Science University of the Philippines, Diliman, Quezon City 1101 Thank you.
TITLE OF WORK
Title
2. TYPE OF LITERARY AND ARTISTIC WORK (
Kindly attach one (1) complete copy or reproduction of the work
- Books, pamphlets, articles and other writings;
- Periodicals and newspapers;
- . Lectures, sermons, addresses, dissertations prepared for oral delivery, whether or not reduced in writing or other material form
- Letters;
- Dramatic or dramatico-musical compositions; choreographic works or entertainment in dumb shows;
- Musical compositions, with or without words;
- Works of drawing, painting, architecture, sculpture, engraving, lithography or other works of art; models or designs for works of art;
- Original ornamental designs or models for articles of manufacture, whether or not registrable as an industrial design, and other works of applied art;
- Illustrations, maps, plans, sketches, charts and three-dimensional works relative to geography, topography, architecture or science;
- Drawings or plastic works of a scientific or technical character;
- Photographic works including works produced by a process analogous to photography; lantern slides;
- Audiovisual works and cinematographic works and works produced by a process analogous to cinematography or any process for making audiovisual recordings;
- Pictorial illustrations and advertisements;
- Computer programs;
2. AUTHORSHIP (Use a separate sheet if needed)
Name(s) of Author(s) Unit/Office Email Address Mobile No.
3. APPORTIONMENT OF RIGHTS
Determine the percentage creative/scientific contribution of each author to the work. The apportionment agreed upon shall also become the basis for income and royalty shares that each inventor shall receive in case of commercialization of the intellectual property. (Use a separate sheet if needed)
Name(s) of Author(s) Share/Contribution to the work (%)
4. SOURCES OF FUNDS
Identify all sources of grants, contracts, and other sources of funds availed of by the author(s). The OVCRD will check the contractual reporting obligations associated with your funding. Please attach copies of said grants or contracts
University of the Philippines System
Constituent University of the UP System
Department of Science and Technology
Others, please specify:
5. FACILITIES/EQUIPMENT
Identify all facilities and equipment used for the production of the research that led directly to the creation of the work. Please attach copies of agreement regarding use of facilities or equipment, if any. (Use a separate sheet if needed)
Name of Agency Facilities/Equipment Location
6. DISCLOSURE
Date when work was completed:*
MM slash DD slash YYYY
Date when work was submitted to the funding agency:*
MM slash DD slash YYYY
Kindly attach acknowledgment or copy of receipt of the work submitted
Max. file size: 20 MB.
7. PUBLICATION
If the work has been published, please attach a copy of the portion of the published work indicating the publisher, date of publication, copyright information, etc.
If the work has not been published, has a publication been planned?
If yes, please specify the proposed publication date.
MM slash DD slash YYYY
8. CERTIFICATION
By submitting this form, I/we, the author(s), hereby:
1. Attest that the information I/we have given is true and correct to the best of our knowledge and that if necessary I/we agree to furnish additional information or documents that may be required by the TTBDO;
2. Agree and consent to such of the University and shall perform all acts and sign all such documents necessary in order to comply with said policies, guidelines and regulations necessary and appropriate steps that the TTBDO may undertake in having this disclosure evaluated and in filing and prosecuting the appropriate intellectual property application/(s) and/or protecting the invention as undisclosed information or a trade secret; and
3. Confirm that I/we are bound to comply with the existing intellectual and other relevant policies, guidelines and regulations
Printed Name of Corresponding Author Date