UNITED NATIONS NELSON ROLIHLAHLA MANDELA PRIZE 2015
NOMINATION FORM
This form must be returned no later than 18 May 2015 by email to mandelaprize@un.org
(preferable way of submitting 2015 nominations) or mail to:
Secretariat
Committee for the UN Nelson Rolihlahla Mandela Prize
c/o United Nations Department of Public Information
Room S-1042
UN Headquarters
New York, N.Y. 10017
U.S.A.
Please note that the information required should be provided on the data sheet. If more space is
needed, please attach additional pages with each page numbered corresponding to item number
in the data sheet.
1. Name of person nominated
2. Address of nominee (including
mailing address, telephone, and
email)
3. Biographical details of nominee
(Country of origin, Date of birth,
Profession/Primary Field of
Activity)
4. Nominated by
(Name/Organization, field of work,
telephone and email)
5. Please present the outstanding achievements and contributions to the purposes and
principles of the United Nations of the nominee which have prompted your nomination:
Data on the nominator