REPUBLIC OF ANGOLA
MINISTRY OF SCIENCE AND TECHNOLOGY
Process Nº____/2015
Registration form for the Fair of Science and Technology and Ideas
Invention and Valuation Products
PERSONAL DATA
FULL NAME:
DATE OF BIRTH:
_______/______/________
F
MARITAL STATUS:
IDENTITY NUMBER:
( ) PRIMARY
EDUCATION LEVEL:
M
GENDER:
( ) SECUNDARY
( ) HIGH/TECHNICAL SCHOOL
( ) TERTIARY INSTITUTION GRADUATE
( ) MASTER (MSc)
( ) DOCTORATE (PhD)
( ) POST-DOCTORATE
PHOTO
PROFESSION/OCUPATION:
NATIONALITY:
PROVINCE:
MUNICIPALITY:
ADDRESS:
TELEPHONE:
EMAIL:
FAX:
WEBSITE:
ADDITIONAL INFORMATION
PATENTS AND PRODUCTS
Nº OF PATENTS
REQUESTED
IN THE ANGOLAN INSTITUTE OF
INDUSTRIAL PROPERTY (IAPI):
YEAR
IN
AGENCIES
ABROAD:
YEAR
Nº OF PATENTS GRANTED
BY THE ANGOLAN INSTITUTE OF
INDUSTRIAL PROPERTY (IAPI):
YEAR
BY
AGENCIES
ABROAD:
YEAR
END PRODUCTS OBTAINED
THROUGH YOUR PROJECT
END PRODUCTS OBTAINED
THROUGH YOUR PROJECT
AND THAT HAVE BEEN
INTRODUCED TO THE
MARKET
HAVE YOU EVER EXHIBIT
IN ANY FAIR
ARE YOU A MEMBER OF
ANY PROFESSIONAL
ASSOCIATION
IN ANGOLA:
YEAR
ABROAD
YEAR
IN ANGOLA:
YEAR
ABROAD
YEAR
YES
NO
YES
NO
COUNTRY:
YEAR
NAME:
DATE OF
MEMEBERSHIP:
_____/__________/_______
Ministry of Science and Technology
Complexo Administrativo Clássicos do Talatona – Rua do MAT, Prédio B, Porta A – R/C, 6º e 7º Andares- Talatona/Luanda-Angola
www.ciencia.ao , www.stconference-angola.og.ao, E-mail: [email protected], Luanda – Angola
INVENTION/CONTENT TO EXHIBIT
Description:
Taking into account the
identified problems and
proposed solutions
(Maximum 250 words)
MINCT – Ministry of Science and Technology
The Exhibitor
………., _______/______________/ 20____ (D/M/Y)
Ministry of Science and Technology
Complexo Administrativo Clássicos do Talatona – Rua do MAT, Prédio B, Porta A – R/C, 6º e 7º Andares- Talatona/Luanda-Angola
www.ciencia.ao , www.stconference-angola.og.ao, E-mail: [email protected], Luanda – Angola