Disclosure Information Form (All fields need to be completed before the form can be submitted) Name Tel Email School Title for your idea Please answer the following as fully as possible 1. Briefly summarise the idea/technology. 2. List any background reading that will help UMIP understand the area of the idea (papers, articles)? 3. What problem does the idea/technology solve? 4. What is the current stage of development of the technology, what work has been done? 5. What is the anticipated use, the applications, the end product? 6. Who do you think are the main customers for your idea (market sectors and specific company names if you have them)? 7. What is/are the competing products or technologies and how is your idea better? Competition (academic or commercial) Advantages of your idea 8. From your search of the academic publications are there any papers that are similar? 9. Are there any relevant patents that you know of (if you don’t know of any leave blank)? 10. Have you published or presented this idea (abstracts, papers, posters, talks etc)? If you plan to soon let UMIP know. Please provide details. 11. What funding has been used to develop this idea? 12. Please provide information about who has worked on this idea with you (optional). NameFunding detailsJob titleUoM Staff/Student Y/N 13. Please list key words for prior art searching. 14. Additional comments/information.