SEC Filings

S-1
AVEXIS, INC. filed this Form S-1 on 01/15/2016
Entire Document
 

 

EXHIBIT E
CHILDREN’S ROYALTY REPORT

 

Licensee:

Agreement No.:

Inventor:

Children’s File No.:

Period Covered: From:            /            /            Through:            /            /

Prepared By:

Date:            /            /

Approved By:

Date:            /            /

 

If license covers several major product lines, please prepare a separate report for each line. Then combine all product line into a summary report.

 

Report Type:                                         o                Single Product Line Report:

 

o            Multiproduct Summary Report:                                                                                             Page 1 of               Pages

o            Product Line Details: Line:                    Tradename:                  Pages:                    

o            Report Currency: o   U.S. Dollars         o Other

 

 

 

Invoice
Amount/Amount
Received if not

 

[*Less:

 

 

 

Royalty

 

Period Royalty Amount

 

Country

 

invoiced

 

Allowances]

 

Net Sales

 

Rate

 

This Year

 

Last Year

 

****

 

 

 

 

 

 

 

 

 

 

 

 

 

****

 

 

 

 

 

 

 

 

 

 

 

 

 

****

 

 

 

 

 

 

 

 

 

 

 

 

 

****

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Royalty:                                                                                    Conversion Rate:                                                 Royalty in U.S. Dollars:  $

 

The following royalty forecast is non-binding and for Children’s’s internal planning purposes only: Royalty Forecast Under This Agreement:  ****

 

Any other consideration due Children’s during this Royalty Period:

 

Milestones:

 

 

 

Minimum Royalties:

Sublicense Payments:

 


****CERTAIN INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE COMMISSION. CONFIDENTIAL TREATMENT HAS BEEN REQUESTED WITH RESPECT TO THE OMITTED PORTIONS.

 



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