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Reagent Disclosure Form

Please read the notes, complete this form and send to:
Disclosures, Cambridge Enterprise Limited, University of Cambridge, Hauser Forum, 3 Charles
Babbage Road, Cambridge, CB3 0GT.
Telephone switchboard: +44 (0)1223 (7)60339, Direct: +44 (0)1223 (7)69278, Fax: +44 (0)1223 (7)63753.
Email: disclosures@enterprise.cam.ac.uk, web: www.enterprise.cam.ac.uk

1. CREATOR(S)
Please list all creators:
Creator(s) Position Department Phone Email

Please nominate one of the creators as the principal contact:

2. SPONSORSHIP OF THE RESEARCH


Note:
Give the applicable contract or grant (RG) number(s), project title(s) and the principal investigator
on the project(s) in the table below if the reagent was made in connection with research funding.
We need to ensure that we fulfil our obligations under research grants and contracts.
a. Was the reagent developed using any research grants/contract funds? Please answer Yes or No.
Contract/RG no Sponsor(s) Project title Principal Date grant
investigator started

b. Is the reagent subject to any other agreements (e.g. material transfer agreement, visitor’s agreement,
consultancy)? If yes, please provide details.

c. Have patient samples been used in the research leading to the reagent? If yes, please provide details.
Please fill in the relevant section 3a, 3b or 3c:

3a THE CELL LINE


Please name the cell line:

Please state the species, i.e. Human, Mouse, Rat or other:

Cell type:

Please give a brief description of the cell line:

3b THE ANTIBODY
1. Please state the name of antibody:
2. Please state the antigen targeted:
3. Please indicate the methods the antibody has been used in, i.e. IHC, IP, ELISA, WESTERN,
AFFINITY, CHROMATOGRAPHY, or other:

4. Please state the type of antibody:

Monoclonal: Is a hybridoma available?

Polyclonal: Antibody purity:

5. Please indicate species in which the antibody was raised i.e. Mouse, Rat, Rabbit or other:

6. Please state antigen species, i.e. Human, Mouse, Rat or other:

7. Please state the isotype, i.e. IgG1, IgG2, or other:

8. Please state the immunogen used:


3c OTHER MATERIAL
Please name the material:
If appropriate, please state the species, i.e. Human, Mouse, Rat or other:
Please give a brief description of the material:

4. RESEARCH AREA
Please provide a brief description of the area of research that the reagent has been used for and an indication
of the relevance of the target:

5. PUBLICATIONS

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Please list any publications in which the reagent has been cited:

6. COMPANIES
Please provide a list of any specialist companies in addition to the established reagent suppliers that you think
may be particularly interested in this reagent:

7. FURTHER INFORMATION
Please provide any further information you think may be helpful:

8. CONTACT
If you have discussed the reagent with Cambridge Enterprise, please give the contact :

9. SIGNATURES (If more than four creators, please complete signature boxes only on a separate form and
append)
By filling in the boxes below I confirm that: I have read the Notes sections and I confirm the
information given above is correct and accurate. I confirm that all creators have reviewed this form and
have agreed to submit this Reagent Submission Form. I understand that I may change my mind about
the commercialisation route after discussion with Cambridge Enterprise.
The University IPR policy requires that you inform your Head of Department about this disclosure.
Have you done so?
Print name: Date: Print name: Date:
Creator’s signature: Creator’s signature:
Home address: Home address:

Print name: Date: Print name: Date:


Creator’s signature: Creator’s signature:
Home address: Home address:

We would like to distribute the creators’ share of any resulting income as follows (please tick):
Equally: Other (give details):
WEBSITE POSTING
Please note that unless expressed otherwise, details of the reagent will be posted under licensing
opportunities on our website.

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