Form

THIRD PARTY AUTHORISATION FORM

You are receiving this link because someone has indicated you as the IP owner of a Solution (product, process or service) that will be submitted for the Solar Impulse Efficient Solutions Label.

Please complete this form in order to authorise a third party to submit a Solution for which you fully and freely own intellectual property rights.

Your Contact Details

Email*

Phone number*

Company name*

Company Website Link*

Official Declaration

on behalf of*

as the effective IP Owner of*

for which fully and freely own intellectual property rights, hereby confirm that*

representing*

has the right to submit an application for the Solar Impulse Efficient Solutions Label in quality of *

Declarations: I acknowledge that

This document does not constitute an Intellectual Property Assignment Agreement, and shall be used only within the scope of the Solar Impulse Efficient Solutions submission and labeling process;

All statements and elements presented or to be presented in the application (Solution Submission Form) do not and will not contain sensitive or confidential information that could jeopardize my intellectual property rights;

The World Alliance for Efficient Solutions should not be held liable for the correctness and completeness of any of the statements and elements provided in the up-mentioned application;

In case of any claims, lawsuits or litigation, e.g. regarding copyright or publishing right, the World Alliance for Efficient Solutions shall not be involved in any such claims, lawsuits or litigation. I shall in any case fully and completely indemnify the World Alliance for Efficient Solutions, as well as its members, board members, employees, agents and representatives, against any and all consequences resulting from or arising out of any breach of this statement, the fact that this statement is incorrect or misleading, or any such claims, lawsuits or litigation.

This authority comes into effect from the date that this form is completed.

First name*

Last name*

Date*

Year/Month/Day

Please provide a scanned version of your signature: *

(PNG, JPG, PDF, JPEG, NPEG)

Please select if relevant :

I am available to be contacted in case further clarifications are needed

I would like to receive information about the outcome of the Solution’s evaluation

I might be interested to be added as a “collaborator” and become a member of the World Alliance

I would like to learn more about the Solar Impulse Label and opportunities