CILT SRI LANKA PINNACLE AWARD 2018 APPLICATION 1 P a g e
APPLICANT/NOMINEE PROFILE 1. Personal Information Name of Applicant/Nominee Address Residence Office Mobile Contact Residence Office e-mail/s Occupation/Profession 2 P a g e
2. Nomination Form AS THE NOMINATOR (if the nominee is nominated by an Individual/Organization//Association) Name of Organization//Association Name of Nominator Address Business Office Contact Office Mobile e-mail/s Occupation/Profession We/I certify that the nominee mentioned in this form is nominated for the CILT SRI LANKA PINNACLE AWARD 2018 by us/me. Signature of Nominator Date AS THE NOMINEE I certify the facts mentioned in this form and give permission to use the facts for publication with the agreement to accept a professional award. I understand barring extreme circumstances, I am required to be present at the official Awards ceremony to be held on 17 th July 2018. Name of the Nominee: Signature of Nominee Date 3 P a g e
3. Certification by the Professional /Association (other than CILT) (if applicable only) Name of the /Association Membership Category Voting Rights (Yes/No) We certify that (Name of the Nominee) is a current member of the /Association and a member for more than 15 years as of 31/12/2017. He / She has voting rights as per the constitution and is a member of good standing. Signature of President/Chairman/Secretary Date 4. Certification by the Organization (if applicable only) Name of the Organization Position/s held by the Nominee We certify that (Name of the Nominee) is currently holding the position/s of. and his / her achievements at the Organization (*) are true and correct. Signature of Head of Organization Date Rubber Stamp 4 P a g e
5. Educational s - Undergraduate Attach certificate copies 6. Educational s - Postgraduate Attach certificate copies 5 P a g e
7. Professional s Attach certificate copies 8. Professional Memberships Attach certificate copies Membership Category Membership Category Membership Category 6 P a g e
9. Professional Achievements Attach proof National International 10. Professional Awards/Recognitions Attach proof National International 11. Achievements at the Organization (*) Brief Description of the Organization Position/s held List of Achievements 7 P a g e
12. Industry Achievements (Projects/Publications/Paper Articles/Research Articles) Attach proof National International 13. Special Achievements (Inventions) Attach proof National International 14. Contributions to Community/Environment Attach proof 8 P a g e
15. Leadership Achievements Please submit a write up, in preferably not less than 1000 but not more than 2000 words as to why the applicant/nominee would be eligible to receive this award. Declaration: I certify the information in this application to be true and correct and I accept that this application could be rejected if any of the information provided herein is found to be incorrect. Signature of Applicant/Nominee Date 9 P a g e
Terms & Conditions 1. The application is also available on the CILT Sri Lanka website, www.ciltsl.com 2. A fee of Rs. 1000, application registration fee will be charged on submission of the application. 3. Professional s certificates must be certified by the. 4. On request, the originals of attached certificates may need to be submitted. 5. Please attached a copy of National Identity Card (NIC) or Passport. 6. Closing date for submitting applications is 31 st May 2018. 7. An independent panel of judges who have no conflicting interest with CILT Sri Lanka or respective applicants will exercise selection of winners and the judge s decision will be final. 8. Current Office Bearers and Members of the Awards and Scholarships Subcommittee of CILT Sri Lanka are not eligible to apply. 9. In the event of Postponement/Cancellation of the CILT SRI LANKA PINNACLE AWARD program CILT Sri Lanka shall not be liable for any damages. 10. CILT Sri Lanka Secretariat 450 D R Wijewardena Mawatha Colombo 10 T: 011 565 7357 / 077 757 9798 E: admin@ciltsl.com www.ciltsl.com 10 P a g e