Nomination Form For Individuals - Un-Habitat
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1
2
3
4Annex 2
Email completed submission to
by Friday, July
st
31
, 2015.
Part 1:
Please complete this section if you wish to nominate yourself for an
award
Details of the applicant/nominee
Name:
Gender:
Designation::
Date of Birth:
Address including Postal Code
E-mail:
Fax Number:
Telephone:
Web address if applicable:
Name of the
invention/Innovation/business
Part 2:
Please complete this section if you are nominating someone for an award
Details of the Person Being Nominated:
Name: Mr./Ms.
Date of Birth
Designation:
Address:
City:
1
Those who nominate Individual applicants are also requested to fill in the details about the nominees in this
form in addition to Annex 2
2
Self-nominees are required to use this form
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