Patent Inventor Disclosure Form¶

CONFIDENTIAL - ATTORNEY-CLIENT PRIVILEGE APPLIES WHEN SHARED WITH COUNSEL¶

Section 1: Invention Identification¶

1.1 Invention Title¶

Primary Invention: ______ Alternative Titles: ______

1.2 Invention Category¶

Section 2: Inventor Information¶

Primary Inventor¶

Field	Information
Full Legal Name
Current Address
Email
Phone
Citizenship
Employment at Conception
Current Employment

Co-Inventors (if any)¶

Name	Role in Invention	Contribution	Contact

Section 3: Conception and Development Timeline¶

3.1 Conception Date¶

Date idea was first conceived: _________

How do you know this date? - [ ] Written records (notebooks, documents) - [ ] Electronic records (code commits, emails) - [ ] Witness testimony - [ ] Other: _________

3.2 Reduction to Practice¶

Date invention was first implemented: _________

Evidence of implementation: - [ ] Working code (commit hash: ___) - [ ] Demonstration to others - [ ] Test results - [ ] Other: _________

3.3 Development Timeline¶

Date	Milestone	Evidence
	Initial concept
	First design document
	First code implementation
	First working prototype
	First customer use

Section 4: Description of Invention¶

4.1 Problem Solved¶

Describe the problem that existed before your invention:

[Write 2-3 paragraphs describing the problem]

4.2 Prior Attempts¶

How did others try to solve this problem before?

[Describe existing solutions and their limitations]

4.3 Your Solution¶

How does your invention solve the problem?

[Describe your solution in detail]

4.4 Key Innovation¶

What is the novel/non-obvious aspect?

[Describe what makes this new and not obvious]

Section 5: Prior Art Awareness¶

5.1 Known Similar Technologies¶

Technology/Product	Company	How Yours Differs

5.2 Known Patents or Publications¶

Patent/Publication	Relevance	Differentiation

5.3 Your Prior Publications¶

Have you publicly disclosed this invention before? (Papers, blog posts, demos, etc.)

Disclosure Type	Date	Description	Public?

CRITICAL: Public disclosure may bar patent rights. List all disclosures within past 12 months.

Section 6: Commercial Information¶

6.1 Commercial Value¶

Describe the commercial importance of this invention:

[Market size, competitive advantage, revenue potential]

6.2 Competitive Landscape¶

Who would this invention block or concern?

Competitor	Their Approach	Impact of Patent

Section 7: Technical Details¶

7.1 Key Components/Steps¶

7.2 Diagrams/Figures¶

Attach or reference: - [ ] System architecture diagram - [ ] Data flow diagram - [ ] Algorithm flowchart - [ ] User interface mockups - [ ] Other: _________

7.3 Code/Implementation References¶

Component	File Path	Key Lines

Section 8: Previous Employment Considerations¶

8.1 Previous Employer Information¶

Field	Response
Previous Employer Name
Employment Dates
Job Title
Relevant Work Area
Date of Departure

8.2 Invention Assignment Agreements¶

I signed an invention assignment agreement
Agreement assigned inventions in: _________
This invention is NOT covered because: _________

8.3 Clean Room Statement¶

Confirm the following:

This invention was conceived AFTER leaving previous employer
No confidential information from previous employer was used
No prior employer's trade secrets are incorporated
Development was done independently on personal time/resources OR new employer resources

Explanation (if needed):

[Provide explanation for any ambiguity]

Section 9: Witness Information¶

9.1 Witnesses to Conception¶

Who saw/heard about the invention early?

Name	Date	What They Witnessed	Contact

9.2 Witnesses to Reduction to Practice¶

Name	Date	What They Witnessed	Contact

Section 10: Certification¶

I certify that the information provided in this disclosure is true and complete to the best of my knowledge. I understand that this information will be used to evaluate patentability and that incomplete or inaccurate information may affect patent rights.

Field	Entry
Inventor Signature
Printed Name
Date

Section 11: Attachments Checklist¶

Technical specification document
Architecture diagrams
Algorithm descriptions
Code samples (relevant portions)
Prior art search results
Timeline documentation (commits, emails)
Employment agreement from previous employer (if applicable)
Witness statements (if available)

For Patent Attorney Use¶

Review Item	Status	Notes
Prior art search complete
Employment agreement reviewed
Public disclosure analysis
Claim drafting commenced
Provisional filing deadline

Form Version: 1.0 Last Updated: December 2025