SPIRIT OF ENTERPRISE AWARD 2017

NOMINATION FORM

ABOUT MY COMPANY

Company Name
Company’s Registered Address
Company Registration Number / Years of Business Operations
Primary Business Activities / Industry / Sector
Company’s Main Line / Fax Number
Email
Website URL
Total Staff Strength / Full-Time:
Part-Time: / No. of Branches / Singapore:
Overseas:
Size of Company
(Please check where appropriate) / Promising Company
Company’s group fixed assets (at net value) must not exceed $1 million or must not exceed 20 staff (for companies in the services sector) / Established Company
Company’s group fixed assets (at net value) are worth from $1 millionand above or have 20 to 200 staff (for companies in the services sector)
Company’s Sales Turnover for the Last 3 Years
(Please check where appropriate) / Year 2016
Under $500K
$500K - $1MIL
$1MIL - $3MIL
$3MIL - $10MIL
Above $10MIL / Year 2015
Under $500K
$500K - $1MIL
$1MIL - $3MIL
$3MIL - $10MIL
Above $10MIL / Year 2014
Under $500K
$500K - $1MIL
$1MIL - $3MIL
$3MIL - $10MIL
Above $10MIL
Other Awards Received by Company

ABOUT THE ENTREPRENEUR

Salutation
(Please delete where inapplicable) / Dr/ Prof/Mr/Mrs/Ms/Madam
Name of Entrepreneur
(Please underline family name)
Designation
Age Group
(Please check where appropriate) / 21 - 30
31 - 40
41 - 50
Above 50
Office Telephone Number (DID) / Mobile Number
Direct Email Address
Name of Contact Person / Personal Assistant / Designation
Contact Person/ Personal Assistant’s Telephone Number / Email of Contact Person/ Personal Assistant

DECLARATION AND SUPPORTING DOCUMENTS

(To be submitted together with this Nomination Form 3A)

Signed Declaration (as follows on page 3 and Page 4 of this form)

Letter of Acknowledgment Interview Transcript (Document 3B)

Nominee Feedback Form (Document 3C)

Latest copy of ACRA print-out

Marketing Collaterals or Corporate Brochure (if applicable)

Financial Statements for the past 3 years (to be submitted directly to the SOE Secretariat)

DECLARATION:

I declare that:

  • All requested information is accurate and to the best of my knowledge.
  • I am a Singapore Citizen or a Singapore Permanent Resident, and I am at least 21 years old.
  • My Company is registered in Singapore and has been in operation for the last 3 years, and is still in business.
  • My Company is in good standing in my industry and with the relevant authorities, and is not involved in any legal proceedings.
  • I own at least 30% of the shares in my Company, and I confirm that Government investment of any nature does not amount to it being a principal shareholder of my Company.

ACKNOWLEDGEMENT:

In addition to the above Declaration, I also acknowledge and agree to the following:

  • Spirit of Enterprise ("SOE") will have the right to use all information gathered frommy interview with the student interviewer assigned by SOE (“the Interview”), including any articles, transcripts, publications, audio and/or video recordings and photographsobtained in connection with the Interview (“the Articles”) in any and all media, in whole or in part – including the posting of the Articles on the SOE website.
  • SOE will own all the rights, title, copyright and any interest whatsoever in the Articles, and I will not make any claim for the rights, title, copyright and any interest whatsoever in respect of the Articles.
  • SOE has the discretion to request for further information in connection with this nomination and all costs required for extracting and delivering of the information and/ or documents will be borne by me.
  • SOE will not be responsible for the loss of the Articles, documents and/or materials.

UNDERSTANDING:

In connection with my nomination for the SOE Award 2017, Ialso fully understandand agree to the following:

  • I will be given the opportunity to review the Articles and suggest appropriate changes. At SOE's request, I will give my written approval to the Articles and Interview transcripts ("Approval") and no further changes will be made after the Approval.
  • I will allow media requests for separate interviews with me, if any.
  • I will be present at the SOE Awards Ceremony to accept the Award, if awarded.
  • SOEwill be entitled to withdraw any Award conferred to me and my Company under certain circumstances; including, without limitation, the following, :
  • The Company and/orI have been convicted of any offence in any jurisdiction.
  • The Company and/or I have been and/or is currently the subject of any proceedings or investigations in respect of any offence in any jurisdiction.
  • The Company and/or I havenot at any time complied with any applicable laws, rules, regulations and/or orders from a competent authority.
  • All information that the Company and/or I have provided to the SOE are untrue and/or incomplete in any respect.
  • I will indemnify SOE against any losses arising out of any breach of award requirements and/or conditions, misrepresentations, false statements, actions and/or omissions by me and/or my Company.

I hereby confirm and agree to the above mentioned Declaration, Agreement,Terms and Conditions and agree to be bound by them.

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NameDesignation

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Authorised SignatoryCompany Stamp

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