ICGN Award CandidateNomination Form 2016

The ICGN has been making awards to individuals who have demonstrated exceptional achievements in the field of corporate governance since 2001. Candidates are nominated by ICGN members and reviewed by the Awards Committee (the Committee) which then puts forward a recommendation to the ICGN Board. The award is made to thesuccessful recipient(s) at the Annual Conference and highlighted on the ICGN website.

ICGN Members are invited to choose to nominate award candidates in one, or both, of the following two categories(1) ICGN Life-time Achiever Award, (2) ICGN Excellence in Corporate GovernanceAward (North America).Awards candidates must be supported by at least three ICGN members.

The following criteria will be considered as part of the award selection process:

The nominee is recognised to have a material period of achievement in corporate governance;

The nominee has markedly improved the state of corporate governance in one or more jurisdictions;

The nominee has produced, or has the potential to produce, an important, positive impact on one or more economies;

The nominee has overcome difficult and challenging obstacles, requiring courage, vision and fortitude; and

The nominee could benefit from recognition by the ICGN in furthering corporate governance achievement.

For the Excellence in Corporate Governance Award, members are invited to choose one, (or more), corporate governance topics that should be highlighted in the relevant market and considered in the award selection process. The Committee encourages members to nominate a candidate that has excelled in the topic(s) chosen in North Americaand explain why the nominee deserves special mention.

Completing theNomination Forms - Please complete the two parts of the Nomination Form;award candidates must be supported by at least three ICGN members.

Part 1:Nominee details– the name of the candidate, the topic and award category,and the reasonsfor nomination.

Part 2:Proposer details – your full name and contact details, including a description of your relationship, (if any), with the recommended award candidate.

Please submit your confidential nominations byFriday19 February 2016 toMarlice Johnson, Membership Co-ordinator:

By email:

By post:ICGN, Saffron House, 6-10 Kirby Street, London, EC1N 8TS

Part 1: Nominee Details

To be completed by an ICGN member wishing to nominate a candidate.

1.1Candidate details

Candidate Name______

(if an organisation, company or other entity, please supply the name of a contact person)

Postal Address: ______

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Telephone: ______

Email: ______

1.2 Award categories

Please select which of the following award types you wish to nominate the candidate for:

  • ICGN Life-time Achiever Award (recognises that the person or organisation has dedicated their life to the cause of improving corporate governance and has demonstrated determination and resilience in overcoming difficulties and barriers to enhance the state of governance practices.)
  • ICGNExcellence in Corporate Governance Award (recognises that the person or organisation has excelled not only in the ICGN Award general criteria but in one or more specific corporate governance topics.Preference will be given to North American candidates this year)

Please choose one -or more- topics relevant to your proposed candidate where he/she has demonstrated exceptional achievements:

  • Shareholder rights
  • Shareholder responsibilities
  • Disclosure and transparency
  • Executive remuneration
  • Legal and regulatory frameworks
  • Corporate responsibility/sustainability
  • Board and shareholder engagement
  • Other, please describe below

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1.3 Demonstrating achievements

Please describe below how the nominee meets the criteria relevant to the type of award you are choosing:

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1.4 Biography

Please attach a detailed biography of the nominee.

Part 2: Proposer Details

2.1 Your contact details

Full Name______

Organisation ______

Telephone______

Email ______

2.2Relationship disclosure

Please describe below the relationship, (if any), between you and your recommended award candidate.

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Signature………………………………………......

Date…………………………………………………

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