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Nomination Form

Step 1: Nominated by

*First Name


Position (if reprsenting an organisation)

Name of the Organisation( if relevant)


*Contact No.


Step 2: Awards(s) you are nominating for:

Step 3: Nominee details:

First Name


Name of the Organisation( if relevant)


*Contact No

* Email

Using the eligibility and selection criteria, providethe following information as an attachment to this nomination form:

Q1. Explain the achivement/s, the background and reason for the nomination

List any other awards recieved by the Nominee.

Attach to the submission clear copies of any newspaper or magazine articles about the Nominee and her his/her achievements

Note : Please use control / Shift key to select multiple files.

Step 4: Referee:

* Name

Organisation( if relevant)

*Title / Position


*Contact No



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