Nomination of internal members

NOMINATION FORM: CONVOCATION EXECUTIVE COMMITTEE Nomination by eligible members of the Convocation, as defined in clauses 69.1 and 69.2 of the CPUT Statute for the election of two (2) Internal Members of the Convocation Executive Committee as contemplated in clause 17.3.6 of the Convocation Constitution DETAILS OF NOMINEE SURNAME: STAFF NUMBER:

ID NUMBER:

COMPANY/ORGANISATION: CONTACT DETAILS: Email address Address Cell Number DETAILS OF NOMINATOR SURNAME: STAFF NUMBER: COMPANY/ORGANISATION: CONTACT DETAILS: Email address Address Cell Number

ID NUMBER:

Declaration by the Nominator: As Nominator and by signing this form, I declare the following: •

I am a member of the Convocation as contemplated in Clause 69 (1) read with 69 (2) of the CPUT Statute.

•

I have read and understand the eligibility criteria for nomination and election of Two (2) Internal Members of the Convocation Executive Committee of the Convocation as per Clause 17.3.6 of the CPUT Convocation Constitution.

•

I acknowledge that all information, including personal information of the Nominee, provided is correct and that I have the necessary permission and consent from the Nominee to provide CPUT with the aforesaid information.

•

I acknowledge that all my information provided is correct and give permission that my personal information may be processed by CPUT, Operator and relevant employees for the purpose of nomination and election of Two (2) Internal Members of the Convocation Executive Committee and processes related thereto.

Signature of Nominator:

Date:

Seconders: Declaration by Seconders: As Seconder, and by signing this form, I declare the following: •

I am a member of the Convocation as contemplated in Clause 69 (1) read with 69 (2) of the CPUT Statute.

•

I have read and understand the eligibility criteria for nomination and election of Two (2) Internal Members of the Convocation Executive Committee as per Clause 17.3.6 of the CPUT Convocation Constitution.

•

I acknowledge that all my information provided is correct and give permission that my personal information may be processed by CPUT, Operator and relevant employees for the purpose of nomination and election of Two (2) Internal Members of the Convocation Executive Committee and processes related thereto.

Details of Seconders (Please provide full first names and surname): ► Seconder 1: ..........................................................................................................................................................................

Signature: ....................................ID no: .................................................Staff no: ………………………….

Cell: ................................... Tel: .......................................... Email: ................................................................

► Seconder 2: ..........................................................................................................................................................................

Signature: ....................................ID no: .................................................Staff no: ………………………….

Cell: ................................... Tel: .......................................... Email: ................................................................

ACCEPTANCE AND UNDERTAKING BY NOMINEE I, the undersigned confirm that I am eligible to be nominated as an Internal member of the Convocation Executive Committee. I hereby, accept the nomination and confirm my willingness to serve and fulfill the duties as an Internal member of the Convocation Executive Committee should I be elected to that position.

I have read and understand the information contained in the CPUT Convocation Constitution, particularly Clauses 17,18 and 19 thereof.

Full Name(s) & Surname: ID Number:

Staff Number:

Date and Place: Signature: Vision Statement by Nominee in support of the nomination: (May be attached as a separate document):

Declaration by the Nominee: 1. I acknowledge that all the information provided is correct.

2. I authorise and consent to the submission of the information, including my personal information to CPUT, Operator and relevant employees to collate, collect, process, store, use and disclosure of such information for the purpose of nomination of the Internal members Convocation Executive Committee and processes related thereto.

3. I am a member of the CPUT Convocation as contemplated in clause 69 (1) read with 69 (2) of the CPUT Statute, and eligible for election to the office of the Internal member of the Convocation Executive Committee.

4. I have obtained my first qualification at the CPUT/PENTECH or CAPE TECH at least five (5) years before the nomination date.

5. I am an Employee or Student (tick the relevant one) at the University.

Signature of Nominee Date:

Please submit duly completed nomination forms, and written motivations supporting the nomination to: ConvoElect@cput.ac.za on or before Saturday, 19 July 2025.