Institute of Inventors - 19-23 Fosse Way, Ealing, London W13 0BZ, UK
e-mail: mikinvent@aol.com     Tel.: +44 (0)20 8998 6372,  +44 (0)20 8998 3540
CONFIDENTIAL INVENTION DISCLOSURE FORM

CONFIDENTIAL DISCLOSURE UNDERTAKING:
The Institute of Inventors agrees to treat invention information and attachments disclosed on this 
form as confidential and never to misuse or disclose it without express consent of the Inventor.
To the President - Institute of Inventors

I wish that my invention titled below be evaluated by the Sifting Committee:-

Invention....................................................................................(title)

Inventor...............................................  Signed............................................ Date:.................

Address ......................................................................................................................................

........................................................................................................................

Tel. No. ..................................(H) ...............................................(W) ..................................
N.B.  First submission fee  included in membership fee.  (Additional submissions @ £40 each).
MEMBERSHIP NO. (if known): ........................................................................
(tick and attach as appropriate)
Patents: / No Patent  / Patent Applied for  /  Patent Granted   /  Patent Lapsed  / 
Models available: / No models / Mock Model / Working Prototype / Production models /
Illustrations available: / Drawings / Free hand sketches / photos /

Users: The invention is for use by ......................................................................................................

Application:.The invention is used for ...................................................................................................................

The advantages of invention are .......................................................................................................

Brief description: The invention comprises ...........................................................................................................

.......................................................................................................................................

.......................................................................................................................................
N.B. Please answer all above questions even if repeated on additional documents.
Please attach available further details together with sufficient information (drawings, photos, etc.,)  to enable the Sifting Committee to evaluate the invention and make recommendations.