Nomination Form

TRIBUTE AWARD

Awarded Annually

Please Note: This award is applicable to revenue producers only.

The nominee’s initials are:
The nominee’s name is:
Your name:
Your relationship to nominee:
How long have you worked with the nominee?

Purpose

This award is intended to recognize, reward and motivate our employees who perform their duties in an outstanding manner.

To be a recipient of this award, the nominee must, in addition to being recognized for a significant achievement,also,on a consistent basis, encompass and reflect our Guiding Principles/Values.

There are two parts to this nomination form that must be completed for your nomination to be considered.

Part 1 – Guiding Principles/Values

This section surrounds our Guiding Principles/Values and requires that you provide examples of how your nominee demonstrates these on a day-to-day basis.

Part 2 – Achievement

This section asks for information pertaining to the achievement that you wish to recognize this nominee for. Please tick the ones that apply and proceed to answer the corresponding questions.

Part 1–Guiding Principles/Values

Please provide examples of how your nominee demonstrates our Guiding Principles/Values on a day-to-day basis. To help you complete this section, some examples of behaviors that follow our Guiding Principles/Values can be found on the main page of your acColades site - document entitled: Job Aid – Nomination Form

People | the best in the business, our competitive advantage

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Integrity | without compromise

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Leadership | ownership and accountability,inspiration and motivation

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Innovation | creatively delivering value

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Quality | validated by our customers

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Teamwork | winning together with customers and stakeholders

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Part 2 - Achievement

Please tick the achievements that apply and then describe the situation by answering the questions below. If you need more space to write your responses, please insert blank sheets as required.

Demonstrate role model behavior – being an example for others to follow.

Symbolize going the extra mile – showing a commitment to succeed above and beyond normal expectations.

Enhance our reputation – showing SCM Insurance Services in the best possible light.

Deliver excellence – making sure that internal and external customers’ needs are exceeded.

  1. Please explain, in detail, the achievement(s) you wish to recognize this individual for.

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  1. What was the outcome of the achievement shown by the nominee? Please ensure you include as much relative information as possible and where applicable, include details surrounding cost savings, revenue generation, etc.

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After you have completed this form, please save it and then send it, via email, to . Your nomination will be considered and the winners will be announcedin first Trailblazer edition of the New Year - starting in January 2009.