Registration Form

1. The identity of the particular invention:

2. Identify the type of license being applied for (e.g. exclusive, partially exclusive, or non-exclusive)

3. Any desired limitations (e.g. field of use, geographic, etc.).

4. Applicant's Identity: Identify the applicant. Provide the name and address of the person, company or organization applying for the license, citizenship, place of incorporation and the name of the parent corporation.

5. Applicant's Correspondence details: List the name, address, and telephone number of the applicant's representative with whom THSTI should correspond and negotiate. The representative must have authority to conduct licensing negotiations for the applicant.

6. Nature and type of the applicant's business: Describe the nature and type of the applicant's business. The description should include any products or services that the applicant has successfully commercialized in the last 5 years and the approximate number of people employed by the applicant. Please submit a company annual report and income/balance sheet [or equivalent] to comply with this field requirement.

7. How the applicant became aware of the invention: Explain how the applicant became aware of the invention sought to be licensed.

8. Is your company a SME: Indicate whether the applicant is a small business firm. Please refer Ministry of Micro Small and Medium Enterprises for this.

9. Commercialization plan: (Provide a detailed commercialization plan for developing and/or marketing the invention. More information on the required components of the commercialization plan is presented below:)

9.1 An overview of how the company plans to use the licensed technology, including but not limited to: (a) developing a new product (b) enhancing an existing technology or product (c) incorporating the technology to improve existing processes.

9.2 If a product is to be developed, include a pro forma income statement for a 3- to 5-year period detailing total and per unit revenues, and direct and indirect expenses resulting from the licensed technology. The pro forma should reflect the proposed licensing terms such as royalties, up front fee, yearly minimums, and duration of the license. In general, provide data relevant to valuation of the technology in the proposed use, based up on market evaluation and research.

9.3 A chart showing what milestones need to be achieved and when. Provide a timeline of key steps or milestones the applicant believes will be required to bring the invention to practical application.

9.4 A statement of anticipated investment of capital and other resources the applicant believes will be necessary to bring the invention to practical application. This statement should include the nature, amount and timing of such anticipated investments.

9.5 A statement of the field(s) of use in which your company intends to apply the technology

9.6 The identified role of the THSTI. Will it be as technical consultant or will THSTI research, design, or other engineering be required? Define anticipated manpower requirements

9.7 A statement of the geographic areas in which the applicant intends to manufacture any products embodying the invention and the geographic areas where the applicant intends to use or sell any products embodying the invention.

9.8 A statement indicating the applicant's sources of funding.

9.9 The participant shall identify its top level management team and key personnel for this effort, including a description of the reporting structure, biographical information, history of relevant experience and business ventures, and professional references for each.

9.10 A statement indicating the applicant's capability and intention to fulfill this plan for development and marketing.

9.11 Market analysis and plan outlining targeted market sector and customers, foreign markets, etc.

10. Previous licenses: Identify any licenses that were previously granted to the applicant under any government owned inventions.

11. Provide a statement, containing the applicants' best current knowledge, pertaining to the extent the invention is being practiced by private industry, the government, or both, and the extent the invention is commercially available. Identify the competing companies and products in the market sector.

12. Other information: Provide any other information the applicant believes will support a determination to grant the requested license to the applicant.

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