CIMA Business Icon 2013
APPLICATION FORM
(Note: this award is open only to Fellow members of CIMA)
Please use extra sheets of paper (A4 only) if necessary.
Adhere to the corresponding numbers 1-14.
1. Applicant’s details
CIMA contact id:
Name in full:
(Please underline generally used first name and surname)
Address (residence):
2. Business details
Designation:
Company:
Company address:
E-Mail
Mobile
3. Corporate statistics (please provide Audited Accounts)
(In LKR Mn’s)
a)
Turnover
b)
Profit after Tax
as at
31 March 2013
as at
31 March 2012
as at
31 March 2011
c) Equity & Reserves
(Please specify how it
was arrived ) **
d)
Total assets
e)
No of employees
** Paid up capital, retained earnings, revaluation reserves, other reserves etc
If the financial year ends on a date other than 31 March, please provide audited financial
statements for the last 3 years as per the audited year ending date.
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CIMA Business Icon 2013
4.
Organizational Overview
No. of years with the present employer
No. of years in present position
No. of employees in the organization
No. of employees directly reporting to you
Nature of your business
5. Special contribution to organisation / society / community ( limit to 200 words)
6. Any other professional affiliations:
Please list any other professional/academic qualification you have obtained.
Awarding body
Qualification
Year of Completion
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CIMA Business Icon 2013
7. Special prizes/awards won.
Type of award
Name of the Award
Year
National
International
8. Career progression (last 15 years)
Place of work
Designation
Date
from
Date
to
Total
no. of
Years
(i) Current designation and the responsibilities undertaken by the individual in the
current job (limit to 200 words)
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CIMA Business Icon 2013
(ii) Promotions achieved during last 3 years
9. Organizational chart showing position of the applicant
Please attach a separate sheet
10. KPIs in terms of
(i)
Visionary leadership
(ii)
Corporate strategy
(iii)
Innovation
(iv)
Risk taking
(v)
Adding value
(vi)
Best practice
(vii)
Employee relations
(viii)
Contribution to the community
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CIMA Business Icon 2013
11. Special achievements of the individual in the work place/
special tasks or projects undertaken
Type of award
Name of the Award
Year
National
International
12. Contributions made to the profession and the institute (limit to 200 words)
13. Other leadership positions held outside the organisation during the past 5
years and any other personal achievements (limit to 200 words)
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CIMA Business Icon 2013
14. Justification
State why you should be elected as the CIMA Business Icon 2013
(limit your statement to 200 words)
Applicant’s signature ………………………..
Date ………………………
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CIMA Business Icon 2013
RETURN YOUR APPLICATION
On or before 2pm on 7 March 2014 to
Sita Kumaradason
Manager Member Services
CIMA Sri Lanka Division
356, Elvitigala Mawatha
Colombo 5
T: 2503882-5/7700955 ext: 213 or
Gayani De Soyza ext: 218
Check List
 Completed application form
 Duly signed rules and regulations sheet
 Attached original and photocopies of supporting documents
I hereby certify that the information given in this application form is true and correct. I
further declare that I shall accept the decision of the judges as final and shall abide by
the rules and regulations of the ‘CIMA LEADERSHIP AWARDS 2013’.
I have no objection in allowing the CIMA Sri Lanka Division to promote me as the
‘CIMA Business Icon 2013’
Please attach evidence that are directly relevant only. All documents pertaining to the
application should be submitted in hard copy only. No electronic formats will be
accepted.
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