FORM FOR THE NOMINATION OF A FELLOW TO SERVE ON THE COUNCIL OF THE INSTITUTE AS AN ELECTED MEMBER FOR CIMA ELECTORAL CONSTITUENCY______ /

(Pursuant to Byelaw 17, and RegulationsIV.1 AND IV.2)

Notes:

  1. Please read the guidance notes and principles document before completing the nomination form.
  2. Your completed form can be submitted by email or by post to the address below prior to the closing date. Faxed and/ or scanned copies of the completed and signed form are acceptable.
  3. If your named nominator is unable to provide his/her original signature on the nomination form, he/she can send their confirmation directly to us at the email address below. The email from the nominator confirming his/her support for your election to Council must include your name, the nominator’s name in full, his/her CIMA Contact ID and must be received before the closing date.
  4. The Corporate Affairs department will acknowledge receipt of the nomination form within 48 hours of delivery. It is however the candidate’s responsibility to ensure that his/her form is complete and that his/her nominators have submitted their confirmation of support prior to the closing date.
  5. In order to avoid uncertainty, it is recommended that, if candidates do not receive such confirmation, they contact the Corporate Affairs Manager directly (tel: +44 (0) 20 8849 2305 / email: ) BEFORE the closing date, to actively seek such confirmation.
  6. If you require additional information or assistance, please contact the Corporate Affairs Manager at the address above, BEFORE submitting your form.

A. / Name (in full):
CIMA Contact ID:
Registered address:
Telephone No:
Email:
Full time business appointment:*
Business address:
*If retired, appointment immediately before retirement and date of retirement:
B. / Details of nominators
Signature
B1 / Name:
CIMA Contact ID:
Grade of Membership:
Registered address:
Signature
B2 / Name:
CIMA Contact ID:
Grade of Membership:
Registered address:
Signature
B3 / Name:
CIMA Contact ID:
Grade of Membership:
Registered address:
Signature
B4 / Name:
CIMA Contact ID:
Grade of Membership:
Registered address:
Signature
B5 / Name:
CIMA Contact ID:
Grade of Membership:
Registered address:
Signature
B6 / Name:
CIMA Contact ID:
Grade of Membership:
Registered address:
C. / The candidates should submit details of service to the Institute e.g. on the Council of any committee, in branches or in some other capacity:
From / Details of Service
D. / The candidates should submit other biographical details not exceeding 200 words in length (a sheet may be attached if required). Please read the“guidance notes and principles” document carefully before completing this section.
E. / Declaration to be signed by candidate
I ______, the undersigned, being a Fellow of the Chartered Institute of Management Accountants and having a registered address in the electoral constituency stated above, hereby confirm the foregoing particulars are correct and declare that I consent to stand as a candidate for election to the Council and that I undertake to promote the interests of the Institute to the best of my ability. In particular I undertake:
(i) / to attend at least the majority of the meetings of the Council
(ii) / to maintain contact with the business of the Regional Boards and branch committees in the electoral constituency for which I am elected
(iii) / to undertake any special work which may be delegated to me by the Council.
Signature:
Date:
On completion this form must be returned by email or by post to:
THE CHARTERED INSTITUTE OF MANAGEMENT ACCOUNTANTS,
26 CHAPTER STREET, LONDON, SW1P 4NP,
clearly marked FOR ATTENTION OF THE CORPORATE AFFAIRS MANAGER
TO ARRIVE AT OR BEFORE NOON ON: Tuesday, 13 January 2015