MMD-MOP-01-05 oe INSTITUTE OF INTEGRATED ELECTRICAL ENGINEERS lee ‘OF THE PHILIPPINES, INC. MOST OUTSTANDING ELECTRICAL PRACTITIONER IN VARIOUS FIELDS NOMINATION/ APPLICATION FORM, Date ‘TO THE AWARDS COMMITTEE: Wei | nominate herein named person ae Outstanding Electrical Practitioner for the year 2010 inthe fild of > Consutancy > Corporate Management > Education > Government & Govemment-Contrlled Corporation > Manufactutingilndustry > Project Management Electrical Contracting > Reseaich and Development xr Photo 1. Full Name arrily Name First ame ‘Age (atthe time of nomination) EE Chapter Afiiation Home Adsross Prosont Postion’ Tit Langth of Tima. ‘Organization! Company Length of Serves Rederoas & Ta. Ne 6. Education BACHELOR MASTERS. DOCTORATE Schoo! Degree Year 7. Professional License, any: < > PEE Year < >REE Year <> RME Year thers: < > Year <> Year & Membership Grade: < > Raguar Member < > Life Nemoor > Senicr Member = 5 Fallow9. Specific qualities or achievements of the nominee which are outstanding! significant, Attach brief description ofthese in separate sheets f necessary, (ase aditional sheets if necessary) 10. Nominator VOUCHER: We hereby cerify that herein nominee is personally Knov to us to be of good reputation and moral character; that, we also know of no conviction’ s or pending case’ s against him; and that we know him to ‘be fully qualified for the award A. BY CHAPTER RESOLUTION ‘Chapter Number ‘Chapter President Printed Name & Signature B, BY INDIVIDUAL ENDORSEMENTS ba, Name PEE/ REE No. ‘Signature b2. Name ——— PEE/REE No: ‘Signature b3. Name — ——___ PEE/ REE No: ‘Signature Note : The above voucher, by Chapter or by Individuals (colleagues in the profession), is a mandatory requirement. The Awards Committee vill not deliberate on any nominee who has not bbeen properly nominated and vouched fr. (Nominaton’ Application Form was revised during the Selection and Awards Committee Meeting on July 2 2008 and was approved by the Board of Governors during the Regular Board Meeting on July 22, 2008.)