Nomination form

Corporate Information

Is your company registered in Singapore?*

Yes
No

Company Name*

Date of Incorporation*

DD

MM

YYYY

Employee Size*

Legal structure of the company*

Private Limited
Public Listed
Government Owned/Linked

Address*

Country

Phone Number*

Fax Number

Company Website

Business Size*

Kindly indicate your annual revenue range below

Contact Person Information

Name*

Designation*

Mobile Number*

Email*

Secondary Contact Person Information

Name*

Designation*

Mobile Number*

Email*

Project Summary

Name of Innovation*

Submission Summary*

Supporting Documents

(LIST below the supporting documents and materials you are submitting to support the project or program, i.e. brochures, photos, press clippings, etc.)

Attachments

Drop files here or

IMPORTANT! A non-refundable Nomination Fee will be charged with every category submission of nomination form. This fee is to cover the administration and audit costs that will be incurred. An additional processing fee of 3% for remittance is included. We will contact you soon for further briefing on the next steps moving forward.

IIA Nomination

Price: $206.00

IIA Nomination

Price: $224.54

Total

Total (including 9% GST + 3% Stripe Processing Fee)

$0.00

Payment

Credit Card

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Declaration

*

I hereby declare that the information submitted herein and as supporting documentation are to the best of my knowledge, true and verifiable. I understand and agree that should any of the information submitted herein and / or any supporting documentation appended herein found to be factually incorrect or are designed to mislead the judges, my nomination will be null and void, and if I’ve been declared a winner, my award will be rescinded. I declare that I am not related to any staff of the Organisers or to any judges appointed by the Organisers (except normal business relationship, if any). I further declare that I have not attempted and will not attempt in any manner, monetary or otherwise, to influence the decisions of the Organisers and/or the judges. I also declare that my business and I have never been investigated for criminal or civil offences at any time in the past or present.

I Agree

Phone

This field is for validation purposes and should be left unchanged.

International Innovation Awards® (IIA)

The International Innovation Awards recognises outstanding innovations, and in the process, provide the encouragement for organisations to continue investing in innovation.

Nomination Form - GST option