Clinical Trial Declaration Intellectual Property (Ip)

Department of Health Government of Western Australia

CLINICAL TRIAL DECLARATION – INTELLECTUAL PROPERTY (IP) Each researcher participating in the Study must complete this form and return it to the Hospital’s Research Governance Unit

Institution The Minister for Health is incorporated as the board of [insert name of hospital] under s7 of the Hospitals and Health Services Act 1927 (WA) and has delegated all the powers and duties as such to the Director General of Health (Institution) Address Hospital Avenue, Nedlands, 6009, WA, Australia Study Name & Number

Your Name & Title (please print)

Address

Contact (‘phone)

1. BACKGROUND INTELLECTUAL PROPERTY

Do you own, or claim to own, any Background □ yes □ no Intellectual Property relating to this Study? If 'Yes', please specify: (provide attachment if required) Acknowledgement (to be signed if ‘yes’ to above question) I agree to grant to the Institution a perpetual, irrevocable, royalty-free and licence fee-free world-wide non-exclusive licence (including the right of sub-licence) to use, copy or modify any Background Intellectual Property that I own, or claim to own, relating to this study. Signature Date

2. PROJECT INTELLECTUAL PROPERTY Acknowledgement (to be signed) I agree that all Project Intellectual Property relating to this Study belongs to the Institution and that the Institution can, at its discretion, assign the Project Intellectual Property to the Study sponsor and / or another entity.

Signature Date

3. THIRD PARTY BACKGROUND INTELLECTUAL PROPERTY

3.1 Are you aware of any third party (-ies) (other than the Institution or the Sponsor) that owns or claims □ yes □ no to own any Background Intellectual Property

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Department of Health Government of Western Australia

relating to this Study?

If 'Yes' specify here: (provide attachment if required)

3.2 Has this third party (-ies) agreed to the use of the Background Intellectual Property in this Study? □ yes □ no If 'Yes' specify here: (provide attachment if required) If ‘No’ do not proceed with the Study, and please contact the Research Governance Unit.

DEFINITIONS Institution means “the Minister for Health is incorporated as the board of [Insert Name of relevant Hospital(s)] under s7 of the Hospitals and Health Services Act 1927 (WA) and has delegated all the powers and duties as such to the Director General of Health”. Intellectual Property means present and future industrial and intellectual property rights, including: (1) patents, copyright, trade, business, company or domain names, rights in relation to circuit layouts, plant breeders rights, registered designs, registered and unregistered trade marks, know how, trade secrets and the right to have confidential information kept confidential, any and all other rights to intellectual property which may subsist anywhere in the world; and (2) any application for, or right to apply for registration of, any of those rights. Background Intellectual Property means information, techniques, know-how, software and materials (regardless of the form or medium in which they are disclosed or stored) that are provided by one party to the other for use in the Study (whether before or after the date of this Declaration), and all Intellectual Property in them. Background Intellectual Property does not include processes or programs that do not relate directly to the research (eg commonly used proprietary word processing programs, spreadsheets, statistical packages etc) . Project Intellectual Property means intellectual property which may result from or be created in the course of the clinical research study named on this form.

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