Università ta’ Malta Tal-Qroqq, Malta
! ! !
VO/606 info@uesa-mt.com www.uesa-mt.com
UESA 2014/2015 COMMITTEE - NOMINATION FORM
!
The following form must be signed by the nominee, the proposer and seconded by another individual. Please use block letters.
!
Section A : Nominee’s Particulars and Declaration
! Name : ______________________ ! !
Gender : _____________________
!
Mob : _______________________
Surname : ______________________ Year of Study : 1st/2nd/3rd/4th Email : ______________________
! Nominee’s Declaration : ! !
I hereby declare that information above is correct and that I am a University Student reading for the B.Eng(Hons.) degree
! Signature : ___________________ ! !
Date : ______________________
Università ta’ Malta Tal-Qroqq, Malta
! ! !
VO/606 info@uesa-mt.com www.uesa-mt.com
Section B : Proposer’s Particulars and Declaration
! Name : ______________________ ! ! Gender : ____________________
!
Mob : ______________________
Surname : ______________________ Year of Study : 1st/2nd/3rd/4th Email : ______________________
! Nominee’s Declaration : ! !
I hereby declare that information above is correct and that I am a University Student reading for the B.Eng(Hons.) degree
! Signature : __________________ ! ! !
Date : ______________________
Università ta’ Malta Tal-Qroqq, Malta
! ! !
VO/606 info@uesa-mt.com www.uesa-mt.com
Section C : Seconder’s Particulars and Declaration
! Name : ______________________ ! !
Gender : _____________________
!
Mob : _______________________
Surname : ______________________ Year of Study : 1st/2nd/3rd/4th Email : ______________________
! Nominee’s Declaration : ! !
I hereby declare that information above is correct and that I am a University Student reading for the B.Eng(Hons.) degree
! Signature : ___________________ ! ! !
Date : ______________________