CIMA Star 2014

Application form

(Note:this award is open only to Associate Members of CIMA)

Please use extra sheets of paper (A4 only) if necessary.
Stick to the corresponding numbers 1-10.

  1. Applicant’s details

CIMA contact id:

NIC no:

Name in full:

(Please underline generally used first name and surname)

Date of Birth: (DD/MM/YYYY)Age:

Address (residence):

  1. Business details

Designation:

Company:

Company address:

Email:

Mobile No

  1. Any other professional affiliations:

Please list any other professional/academic qualification you have obtained.

Awarding body / Qualification / Year of Completion
  1. Career progression post ACMA

Place of work / Designation / Date
from / Date
to / Total no. of Years
  1. Your contribution to your organisation(Maximum 100 words)
    Note: Please obtain endorsement from your organization on your contribution. Chief Executive Officer / Managing Director to endorse
  1. Your contribution to the society (limited to 100 words)
  1. Recognitions achieved internationally / locally - individually or through your organisation in the recent past (Post membership)

CIMA Prizes

Year / Sri Lanka Prizes / World Prize
Stage Prize
Subject Prizes
Subject

Any other awards won in academic, social activities, sports, music/theatre/art?

Type of award / Name of the Award / Year
National
International
  1. Your contribution to CIMA ( in 100 words only)
  1. Describe approximately in 100 words what you wish to achieve in 5 years’ time.
  1. Personal statement as to why you should be elected as the CIMA Star of the Year. (Limit your statement to 100 words)

Proposer

Name in Full………………………………………………………………………

CIMA contact ID…………………………………………………………………..

Organization………………………………………………………………………

Designation………………………………………………………………………

Office Address………………………………………………………………………

Contact Numbers 1,Office…………………….

2.Mobile……………………….

3.Official email……………………….

Signature ………………………………….Date………………………………

Seconder

Name in Full ………………………………………………………………………

CIMA contact ID (if applicable)……………………………………………………

Organization………………………………………………………………………

Designation……………………………………………………………………….

Office Address……………………………………………………………………

Contact Numbers 1,Office…………………………..…..

2.Mobile ……………………………..

3.Official email……………………….

Signature …………………………………Date………………………………

RETURN YOUR APPLICATION

On or before 2pm on 7 September 2015 to

Gayathrie Saravanan

Manager Member Development

CIMA Sri Lanka Division

356, Elvitigala Mawatha

Colombo 5

T: 2503882-5/7700955 ext: 213 or

Gayani De Soyza ext: 218

Check List

 Completed application form

 Duly signed rules and regulations sheet

 Attached originaland photocopies of supporting documents

I hereby certify that the information given in this application form is true and correct. I further declare that I shall accept the decision of the judges as final and conclusive and shall abide by the rules and regulations of the ‘CIMA LEADERSHIP AWARDS 2014’.

I have no objection in allowing the CIMA Sri Lanka Division to promote me as the ‘CIMAStar 2014’

Please attach evidence that are directly relevant only. All documents pertaining to the application should be submitted in hard copy only. No electronic formats will be accepted.

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