asia pacific future100 (2009) nomination form

8/14/2019 Asia Pacific Future100 (2009) Nomination Form

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Nomination Form

Nomination closing date: Monday, 31st August 2009. When completed please return to:

[email protected]. Please name your file: “nominee name _ country”.

First name: Last name:

Telephone: Email:Address: Country:

Occupation: Date of Birth:

Highest academic qualification high school bachelor master postgraduate

Previous awards:

Name of the Business/ NGO/ project:

Address:

Website:

Month/Year of establishment: Business registration number:

No. of fulltime employees: No. of part-time employees: No. of volunteers:

Is the Business/ NGO/ project founded by you? Yes No

Did your Business/ NGO/ project start operations at least 12 month prior your AP Future100 application?

Yes No

1. Please describe your business/ NGO/ project. [main objective(s), idea(s), concept(s),impact]

Contact Information Nominee:

Business/ NGO/ project information:

mailto:[email protected]





Nomination FormNominee name:

2. Please provide an overview of your products and services.

3. How is this business/ project innovative?

4. What do you want to achieve with your business/ NGO/ project?




5. Please elaborate why you started your own venture. How did you come up with the idea?What inspired you?

6. What challenges did you have to overcome? How did you succeed?

7. What has been your and your ventures biggest success and your biggest failure been sofar?




8. Where do you want to take your venture? Where do you see your business in 10 years?

I hereby declare that I read the terms and conditions of the Future100 and agree to all terms andconditions with my signature below. I further declare than the information submitted herein and assupporting documentation are to my best knowledge, true and verifiable. I understand and agree thatshould any of the information submitted herein and as supporting documentation are found to be

factually incorrect or are designed to mislead the judges, my nomination will be voided, and if I’ve beendeclared a winner, my award will be rescinded. I declare that I am not related to any staff of theOrganizers or to any judges appointed by the Organizers. I further declare that I have not attempted andwill not attempt in any manner to influence the decisions of the Organizers and/or the judges.

Name: Date and Place: Signature Nominee:

Supporting documents:1. 2 recommendation letters about the Entrepreneur

Organizational Marketing Material incl. brochures/ website screenshots, flyers etc.3. soft copy of passport/ national ID card4. CV of entrepreneur incl. copies of any awards achieved

How did you get to know about Future100?

Nominee Declaration

asia pacific future100 (2009) nomination form

Documents