A. Information About the Entity Or Individual Being Nominated
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Philanthropy Award 2017
Nomination Form
A. Information about the entity or individual being nominated
Name of the business entity and its representative Name, Surname (if an individual) Address: City/Commune: Telephone: E-mail:
B. Information about the entity or individual that nominates
Name of entity (business company, institution, NPO etc.) Name, Surname (if an individual) Address: City/Commune: Telephone: E-mail:
C. Information about the entity or individual being nominated and their philanthropic activity during the last 12 months
In which of the following categories is this entity or individual being nominated for:
Award for Business Entities Contributing at the National Level Award for Business Entities Contributing at the Local Level Award for Individual Contribution
Please describe the reasons for this nomination:
Please shortly describe how it has contributed during the last 12 months, to the community and its development.
Please provide information on the period, location this activity took place, type of contribution given (money, products, services) and amount of the contribution.
Please provide information about the beneficiary groups and what they have benefited.
Please list three benefitiaries who can support your nomination. Provide their contact information as below:
Name:
Surname:
Telephone:
Email:
Name:
Surname:
Telephone:
Email:
Name
Surname
Telephone