Inventors
Submissions Form
Name:
Email Address:
Company Name:
(If Available)
Address:
Telephone:
1. Please enter a descriptive title for this submission.
2. Abstract (150 words max.) Please describe your technology in terms of benefits delivered and how it differs from what is currently available.
3. Summary (200-500 words max.)
Provide a NON-CONFIDENTIAL overview of the technology, which gives the reader an immediate impression of the nature of the technology and its relevance and potential use. Give a brief description of the different components in order to evaluate and identify potential/future applications of this technology.

What are the potential applications for this technology?

What are the key innovative features and benefits of the technology?

4. What is the current stage of development?
5. Documentation and Information on Technology

Please list information and documentation supporting the technology, stating whether it is public or confidential. Confidential information will be accepted only after an authorized officer of The MIBRO Group has signed a confidentiality agreement.

6. Intellectual Property Rights

Using the table below indicate any intellectual property rights.
Patent
Applied for:		 Yes No
Provisional
application:		 Yes No
Patent search
carried out:		 Yes No

Patent
obtained:

 Yes No   Number:
Registered
Design:		 Yes No   Number:
Trademark
Applications:		 Yes No   Number:
Copyrights: Yes No   Number:
Other: (Please specify)

7. Key "Collaboration Sought"

R&D - Furthur Research or Development
License Agreement
Manufacturing Agreement
Others:

8. Background Information:

Please list all information of any third party working in the performance/development of this technology. This includes applications, patents, registered designs, copyrights, and other similar statutory rights.

9. Disclaimer:

Yes, I hereby certify that the above information is non-confidential and I have ownership of any technology or am empowered by the owner of any technology to offer the technology to The MIBRO Group for consideration.

Date: ________________ ________________________
(Signature of Inventor)
Date: ________________ ________________________
(Signature of Witness)
Print this form, along with our Submissions Policy Form, then mail both to the attention of the Vice President of Product Development & Quality Engineering to:

The MIBRO Group
111 Sinott Road
Scarborough, ON M1L 456