Fill and Sign the Licensee Form

Assignment of Rights under License Agreement by Licensee Assignment made on the ______________ (date) , between by ____________________ (Name of Assignor) , a corporation organized and existing under the laws of the state of _________________, with its principal office located at ________________________________ ______________________________________________ (street address, city, county, state, zip code) , referred to herein as Assignor , to _________________ (Name of Assignee) , a corporation organized and existing under the laws of the state of ______________, with its principal office located at ________________________________________________________ ______________________ (street address, city, county, state, zip code) , referred to herein as Assignor . Whereas, on _________________ (date) , Assignor entered into a License Agreement with ______________________ (Name of Licensor) , a corporation organized under the laws of ______________ (name of state) , having its principal office at ________________________ _______________________________________________________ (address of Licensor) (the Licensor ), under the terms of which Assignor received a License with respect to United States Patent No. _____________ (number) , issued _______________ (date) , for an invention entitled _______________________ (title of invention) and described generally as follows: (description of invention) _____________________________________________________. A copy of the Agreement is attached hereto as Exhibit A and made a part of this Assignment by this reference; and Whereas, Assignor has the right to assign its rights under the Agreement; Now, therefore, in consideration of $____________ received from Assignee by Assignor, Assignor assigns to Assignee all of Assignor's right, title, and interest in and to the above- mentioned License Agreement. Assignee shall enjoy rights and privileges under the Agreement as fully and entirely as the same would have been enjoyed by Assignor if this Assignment had not been made. Witness my signature this _________________ (date) . ___________________________ (Name of Assignor) By: ______________________________ (P rinted Name & Office in Corporation) ______________________________ (Signature of Officer) _______________________ (Name of Licensor) hereby consents to the above assignment. Witness my signature this __________________ (date) . _____________________________ (Name of Licensor) By: _______________________________ (P rinted Name & Office in Corporation) ________________________________ (Signature of Officer)