STATEMENT OF OWNERSHIP OF THE INVENTION

(BY INVENTOR)

The undersigned below :

No. Name and Address of the Inventor (s) *) Citizenship/ email address
if any)
1.
2.
3.
4.
5.

By this we / I declare that, Invention entitled: ...................

.................................................. .................................................., ................ are owned
by me / us and not imitate or unauthorized use of the invention (before the right
of the Invention transfered to the legal entinty, if the applicant not inventor it
self).

This statement I make with the truth and to be used as appropriate.

.................., .................... 20.....

Inventor (s) **)

1. ..............................
2. ..............................
3. ..............................
4. ..............................
5. ..............................

Note:
*) use other page if necessary
**) if approved by the other inventors, the signature can be represented by one of the designated
inventors