Please print, complete, sign & post 

Confidential Disclosure Undertaking & Evaluation Request:
The IoI undertakes to treat as confidential  all Potential Proprietary Invention Disclosures
and not reveal same without Inventor’s consent.

To the President
The Institute of Inventors – 19/21/23 Fosse Way – Ealing, London W13 0BZ, UK

Please evaluate my invention for merit –
Novelty – Is it New? Functionality – Can it Work? & Commercial Viability – Is it profitable?

Invention title…………………………………………………………….…………

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

Address…………………………………..……………………………

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Tel: home: ……………… work: …………..…Mob: ………………..…Email: ……………….…
Membership No. ……………………………………..

N.B. 1^st evaluation request per year free. (additional requests are £40 each).
World Patent & Product Search: If idea is not available in the UK,
we may advise an IoI world patent & product search cost £140 – click here for WPPSearch.

Patents: *| No Patent | Patent Applied for | Patent Granted | Patent Lapsed |
Models: | No models | Mock Model | Working Prototype | Production models |
Drawings available:* | Drawings | Free hand sketches | photos |
*circle and attach relevant documents with form.

Who would buy invention: ……………………………………………………………………………
Uses: ………………………………………………………………………………………….…….…
Benefits: ………………………………………………………………………………………..……
Brief Description: ……………………………………………………………..…………….…. ………………………………………………………………………………………..…………………
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N.B. Please answer all questions even if given on other documents. 

Institute of Inventors
A non-profit Inventor Institute established 1964
President – Michael V. Rodrigues – B.Sc. Eng. (Mech & Elect)
19-21-23 Fosse Way, Ealing, London W13 0BZ
Tel: #44 (0)20 8998 3540, #44 (0)20 8998 6372   email: mikinvent@aol.com  
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