国家卫生研究院技术移转企划书

国家卫生研究院技术移转企划书NationalHealthResearchInstitutesTechnologyTransferProposal1、基本资料(A.InformationaboutApplicant)□非专属授权(Non-exclusiveLicense)□专属授权(ExclusiveLicense)申请日期：中华民国年月日FilingDate:__/__/20__ （公司）公司名称NameofCompany 成立日期DateofIncorporation （公司）英文名称NameofCompanyinEnglish 资本额Capitalamount 负责人NameofCompany’sLicensingRepresentative 去年度营业额GrossTurnoverin2009 工厂登记编号RegistrationNo.ofFactory 公司地址AddressofCompany 联络住址MailingAddressofCompany 电话TelephoneNo. E-mail 传真FaxNo. 员工人数NumberofEmployees 研发人员人数NumberofEmployeesinR&D 立约代表人AuthorizedRepresentativeoftheLicenseAgreement 职称Title 本案联络人ContactPersonofthisApplication 职称Title 联络电话TelephoneNo.ofContactPerson E-mailofContactPerson 联络传真FaxNo.ofContactPerson 检附资料RequiredAttachments □营运计画书(Businessplanoroperationplan)□公司设立\变更登记影本(用印公司大小章)(PhotocopiesoftheCompany’sIncorporationApprovaldocument)*Alltheabovedocumentsmustbeendorsedofficiallybythecompanywithsignatureorcompanyseal. ＊请仔细研读以下问 题 快递公司问题件快递公司问题件货款处理关于圆的周长面积重点题型关于解方程组的题及答案关于南海问题 并据实勾选以表声明(Pleasereadthefollowingquestionscarefullyandprovideanswersaccordingly)：1.本公司为依法登记且二年内无违法纪录，并从事或即将从事与计画内容或技术性质相关业务者(Thecompanywasincorporatedandapprovedbylawanddoesnothaveanyrecordofmisconductorconvictionforanyoffensewithinthepasttwoyearsandiseitherengagedinorisabouttoengageinbusinessrelatedtotheutilizationofthelicensedtechnology.)---------□是(Yes)□否(No)2.本公司有依法缴交营利事业所得税(ThecompanyfiledandpaidtheProfit-seekingEnterpriseIncomeTaxregularly.)--□是(Yes)□否(No)（请妥善保存相关资料，以供本院应主管机关要求备查。Pleasekeeprelevantinformationforfuturereferenceincaseofneed.）3.与本院重大关系纪录(Ifany,pleaselistanypriorcollaborationorsimilarrelationshipwithNHRIinbelowtable.)日期本院联络人洽询/委托/合作/技转研究项目Date NHRIContactPersonInquiry/Commission/Collaboration/PatentLicensing/Technologytransfer__________________________________________________________________________________________________________________________________________________________________4.重要产品/营业额(请附产品目录及产品说明书一份)(Descriptionofyourleadingproduct(s)andrelatednetsale(s).Pleaseuseadditionalpaperandattachproductcatalogue(s)andproductinstruction(s).)5.单位组织架构(请以简单图表表示)(Organizationchart-pleaseuseasimplediagram.)6.开发、生产销售等大事纪(Company’shighlightsonR&D,production,salesandmarketing.)(民国)年(Year)事件说明(DescriptionofEvent)______________________________________________________________________________________________________________________________________________________7.关系企业/协力厂(请选择性提供，有助於内部审查)(ListanyAffiliate/Thirdparties.Pleaseprovidetheinformationselectively;itwouldserveaspartofthefoundationforlicensingdecisions.)产品(Product(s))：2、现况与计画(包含技转名称、预期用途、技术移转步骤及达成时间、後续发展及及後续投入等;如不敷使用，请自行以A4纸加页)B.TheCurrentSituationandPlan(includethenameanddescriptionofproduct(s)ormethod(s)tobedevelopedwiththelicensedtechnologyand,foreachproductormethodtobedeveloped,adescriptionofexpectedproductuseanddevelopmentprograms,including(whererelevant)majorpreclinical,clinical,regulatory,manufacturingandmarketingstages;monetaryandpersonnelcommitmentsforeachdevelopmentstage;andtheprojectedtimetoaccomplisheachstageofcommercialdevelopment,etc.Pleaseattachseparatepaperifmorespaceisneeded.)Icertify,tothebestofmyknowledge,thatalloftheinformationprovidedonthisapplicationandonattachmentstothisapplicationistrueandaccurate.代表人（签章）：SignatureofApplicantorAuthorizedRepresentativeDate申请单位(用印)：___________PrintName代表人职称：______________Title填表日期：年月日