CIMA Business Icon 2014

APPLICATION FORM

(Note: this award is open only to Fellow members of CIMA)

Please use extra sheets of paper (A4 only) if necessary.
Adhere to the corresponding numbers 1-14.

1. Applicant’s details

CIMA contact id:

Name in full:

(Please underline generally used first name and surname)

Address (residence):

2.Business details

Designation:

Company:

Company address:

E-Mail

Mobile

3.Corporate statistics (please provide Audited Accounts)

(In LKR Mn’s) / as at
31 March 2014 / as at
31 March 2014 / as at
31March 2014
a)Turnover
b)Profit after Tax
c)Equity & Reserves
(Please specify how it was arrived ) **
d)Total assets
e)No of employees

** Paid up capital, retained earnings, revaluation reserves, other reserves etc

If the financial year ends on a date other than 31 March, please provide audited financial statements for the last 3 years as per the audited year ending date.

4.Organisational Overview

No. of years with the present employer
No. of years in present position
No. of employees in the organisation
No. of employees directly reporting to you
Nature of your business

5.Special contribution to organisation / society / community ( limit to 200 words)

6.Any other professional affiliations:

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

Awarding body / Qualification / Year of Completion

7.Special prizes/awards won.

Type of award / Name of the Award / Year
National
International

8.Career progression (last 15 years)

Place of work / Designation / Date
from / Date
to / Total no. of Years

(i)Current designation and the responsibilities undertaken by the individual in the current job (limit to 200 words)

(ii)Promotions achieved during last 3 years

9.Organisational chart showing position of the applicant

Please attach a separate sheet

10.KPIs in terms of

(i)Visionary leadership

(ii)Corporate strategy

(iii)Innovation

(iv)Risk taking

(v)Adding value

(vi)Best practice

(vii)Employee relations

(viii)Contribution to the community

11.Special achievements of the individual in the work place/ special tasks or projects undertaken

Type of award / Name of the Award / Year
National
International

12.Contributions made to the profession and the institute (limit to 200 words)

13. Other leadership positions held outside the organisation during the past 5 years and any other personal achievements (limit to 200 words)

14.Justification

State why you should be elected as the CIMA Business Icon 2014

(Limit your statement to 200 words)

Applicant’s 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 original and 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 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

‘CIMA Business Icon 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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