147 High Street, Georgetown
Tel #: (592) 225-9871 / Cell #: (592) 675-9901
Website: http://tec.org
Email: tecofficial@gmail.com
NOMINATION FORM
A. PERSONAL DATA
Candidate ID Number
Date
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Candidate First Name
Candidate Last Name
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Candidate Telephone #
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Address
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Date of Birth
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Nationality
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Sex: Male ☐ Female ☐
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147 High Street, Georgetown
Tel #: (592) 225-9871 / Cell #: (592) 675-9901
Website: http://tec.org
Email: tecofficial@gmail.com
B. POLITICAL INFORMATION
Party
Constituency
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C. EDUCATIONAL BACKGROUND
Highest Level of Education
Primary School ☐
Secondary School ☐
Tertiary Level ☐
Others ☐
Highest Degree obtained
MS ☐
B Sc ☐
MBA ☐
MCA ☐
Others ☐
D. WORK EXPERIENCE
Current Occupation
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Institution
Designation
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E. DECLARATION
I Enter First and Last Name hereby declare that the details furnished above are true to the
best of my knowledge.
147 High Street, Georgetown
Tel #: (592) 225-9871 / Cell #: (592) 675-9901
Website: http://tec.org
Email: tecofficial@gmail.com
Candidate Signature
Witnessed by
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Date
Date
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