Personal Details
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| Surname* | |
| First Name* | |
| Home address* | |
| Postcode* | |
| Date of birth* |  |
| Telephone* | |
| E-mail* | |
Organization details
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| Organization full name* | |
| Address* | |
| Work tel* | |
| Personal work email* | |
| Main activity of business* | |
| Annual turnover* | |
Personal work details
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| Position* |
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| Full job title* | |
| Reporting to (JOB TITLE) | |
Business experience
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| Number of years business experience | |
| Number of years a director/partner present organizations | |
| Number of years a director/partner pervious organizations | |
Previous organizations
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| Name* | |
| Turnover* | |
| Job title* | |
| No of years* | |
| Name | |
| Turnover | |
| Job title | |
| No of years | |
Education
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| Education (Degree) | |
| University/ Colledge | |
| Specialization | |
| Enrollment Date | |
| Graduation Date | |
| Certificates/Diplomas from Specialized |
|
| Director Training Programs |
|
| Publications in the Area of Corporate Governance and Director Affairs |
|
Membership
|
| Desired Membership Status |
|
| Please enclose your photo | |
| Other information (recognition and achievements) | |
Declaration
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I agree to
- Be guided by the spirit of independence in employing relevant experience and knowledge for the benefit of the company;
- Respect the truth, act with integrity and candor;
- In their day-to-day activities promote high ethical and professional standards for independent directors;
- Be guided by the equitable treatment of all shareholders;
- Enhance informational transparency of the company;
- Avoid the potential conflicts of interest and immediately notify all interested parties should circumstances arise that may compromise their independent status;
- Act proactively to convey the best Board practices;
- Maintain his or her professional development in order to keep abreast of the leading corporate governance practices;
- Participate in IDA activities and contribute to its development.
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| I agree* |
|
| Date | |
 | Enter symbols on a picture*
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