Patent/ IP Licensing Partnership - Interest Form / Become Our Partner

Company Name *

Legal Entity *

Corp
LLC
Partnership
Other:

Other, explain: *

Website *

Headquarters City/Country *

Primary Contact Name & Title *

E-mail *

Phone Number *

Secondary Contact (Legal/BD): *

Phone *

Email *

Industry & Category *

Food tech
Materials
Software
Biotech
Devices
Other: ______

Intended Application/ Product *

Development Stage *

Concept
Prototype
Piloting
Market‑ready

Manufacturing/ Development Plan (high-level) *

Target Markets/Territories *

Patent Numbers/ Filings (if known) *

Jurisdiction *

US
EU
UK
CN
JP
Other: ______

Other, explain here: *

Associated Know-how / Trade Secrets *

Yes
No

Freedom to Operate (FTO) Concerns *

None known
Needs review
Known risks (describe)

Scope of Rights *

Research
Evaluation
Commercial
Field‑limited
Territory‑limited

Exclusivity *

Non‑exclusive
Exclusive (Field/Territory: ______)
Time‑limited exclusive

Sublicensing *

Not allowed
Allowed with consent
Allowed (reporting required)

Improvements/ Derivatives *

Assign to Licensor
Grant‑back non‑exclusive
Joint ownership
Discuss

Confidential Information Handling *

NDA required
Data room access upon NDA

Financial Structure *

Upfront License Fee (indicative): $ ______
Running Royalty (net sales): ______ %
Milestones (dev/launch/regulatory): $ ______ / event
Minimum Annual Guarantee: $ ______
Reports & Audits: ☐ Quarterly reports ☐ Annual audit right

Compliance & Regulatory *

Regulatory Pathway (if applicable): ☐ FDA ☐ EFSA ☐ CE ☐ Other: ______
Standards/Certifications required: __________________________________
Export Controls / Sanctions considerations: ☐ None ☐ Needs review
Open‑source or third‑party components (software): ☐ None ☐ Present (licenses): ______