ࡱ> ce`ab%` RBbjbj"x"x e@@y2)LLLL@@@8xtlL@(hhhSSS$hh ~]}1"S}}LLhh$JKKK}L8hhK}KKXh @_5(%| nl]h ) P LS5XKSSS^SSSl}}}}D SfNfLLLLLL  SINGAPORE  Nomination Form ASEAN BUSINESS AWARDS  Nomination Deadline 30 June 2010 SHAPE \* MERGEFORMAT  ASEAN Most Admired Enterprises  CHECK-LIST  Before you send in your nomination form, please ensure these items are followed and completed: Complete this nomination form and return to your ABA National Gateway by 30 June 2010: MS. LOW SIN LENG / MS. JULIANA GIAM ASEAN-BAC Singapore (National Gateway) c/o Singapore Business Federation 10 Hoe Chiang Road # 22-01 Keppel Towers Singapore 089315 Tel: + 65 6827 6885 | Fax: + 65 6720 2873 | Email: jgiam@sbf.org.sg Companies may also submit nomination form directly to: ASEAN-BAC SECRETARIAT 70 A, Jl. Sisingamangaraja Jakarta 12110, Indonesia Tel: + 6221 726 2991 ext 491 | 722 0705 (DL) Fax: + 6221 722 0539 Email:  HYPERLINK "mailto:aseanbac@asean.org" aseanbac@asean.orgORKPMG LIMITED (Competition Strategic Partner) 16th Floor, Pacific Place 83B Ly Thuong Kiet Street Hoan Kiem Dist., Hanoi, Vietnam Tel: 84 (4) 3946 1600| Fax: 84 (4) 3946 1601 E-mail:  HYPERLINK "mailto:timaman@kpmg.com.vn" timaman@kpmg.com.vn Online nomination form may be obtained directly from above organizations, or downloaded from  HYPERLINK "http://www.asean-bac.org" www.asean-bac.org Nomination form must be signed by the Chief Executive Officer, or equivalent Enclose copy of the Registration Certificate of the Company If financial statements are audited, please enclose a set of the Audited Statements Enclose copy of the Residence, Passport or Identification Card of the Nominee (CEO of the Company, or equivalent) Enclose copy of latest Annual Reports if available and sustainability/CSR reports as relevant The nomination form can be completed by anyone, including the nominated organization. Entry submission, with supporting documents and materials, should be in English. Any information provided in this form will be confidentially treated and will only be used by the Strategic Partner and Judges during the review and selection process. The award entry submission will not be returned. SECTION 1: ELIGIBILITY CRITERIA  LARGER SIZE COMPANY To be considered for the ASEAN Business Awards, the category for a larger company must: Be an ASEAN-incorporated enterprise with at least 40% ASEAN-owned equity and have operational presence in two or more ASEAN countries Be in operations for a minimum of five years and must have three years of financial statements Fulfill one of the following conditions: - Annual revenue of a minimum of US$20 million - Fixed assets of more than US$10 million - Minimum of 300 employees SMALL AND MEDIUM ENTERPRISE (SMEs) To be considered for the ASEAN Business Awards, the category for an SME must: Be an ASEAN-incorporated enterprise with at least 40% ASEAN-owned equity preferably with operational presence in two or more ASEAN countries Be in operations for a minimum of three years and preferably two years of financial statements Fulfill one of the following conditions: - Annual revenue of less than US$20 million - Fixed assets equal to or less than US$ 10 million - Less than 300 employees If the nominated company meets with all the eligibility conditions, please return the completed nomination form, typed or handwritten. All nominations shall be acknowledged by the National Gateway. SECTION 2: GENERAL INFORMATION  A. Organization Information Organization Name (English): _____________________________________________________________________ (Chinese / Malay / Tamil / Others): Organisation Address: ___________________________________________________________________________ Telephone:______________________ Fax : _______________________ Email: : ___________________________ Website (if any): ________________________________________________________________________________ B. Key Personnel (Nominee) Chief Executive Officer or equivalent | Salutation: ( Mr. ( Mrs | Ms. _____________________________________________________________________________________________ Chief Operating Officer or equivalent | Salutation: ( Mr. ( Mrs | Ms. _____________________________________________________________________________________________ Chief Financial Officer or equivalent | Salutation: ( Mr. ( Mrs | Ms. _____________________________________________________________________________________________ C. Capital Structure (i) Individual Shareholders Please provide the names of all main individual shareholders and their nationalities (please attach a separate sheet if the space provided is insufficient): Name of ShareholderNationalityDesignation in OrganisationPercentage of Shareholding (ii) Company Shareholders Please provide the names of all main company shareholders, if relevant (please attach a separate sheet if the space provided is insufficient): Name of CompanyCountry of RegistrationCompany Registration No.Business ActivityNumber of StaffPercentage of Shareholding SECTION 3: BUSINESS INFORMATION  A. Main Business Activities (Please tick where appropriate) ( Agriculture / Agribusiness/Fisheries ( Business / Engineering Services ( Food & Beverage ( Healthcare Services ( Hospitality / Travel / Tourism ( Information and communications Technology / High Tech ( Transportation/Logistics ( Mining/energy ( Real Estate / Construction ( Wholesale / Distribution / Retail ( Manufacturing (electronic, automotive, textiles, apparel, etc.) ( Others (please specify) ____________________________________________________________________ Please provide a brief description of the organization and its business in no more than 150 words. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ B. Please rank your strength of the categories conferred under ABA 2010 (1 being strongest and 4 being weakest) ___ Growth ___ Employment  ___ Innovation  ___ Corporate Social Responsibility  Please provide an elaboration on why you should be considered for the category you have chosen in no more than 250 words (please refer to Attachment A). _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ C. Financial Information (i) In which year was the organisation incorporated? ____________________________ (ii) In which country was the organisation incorporated? __________________________ (iii) Please indicate if the organisation is listed on any stock exchange(s): %Yes % No If organisation is listed, please indicate year of listing and the stock exchange(s) it is listed on ___________________________________________________________________ (iv) Please indicate the following organizations details: FY 2007 2008 (US$)FY 2008 2009 (US$)FY 2009-2010 (US$)aRevenue- Local Revenues- Overseas Revenues- Intra-ASEAN Revenue (as a percentage of Overseas Revenue)bShareholders' Equity- ASEAN - Non-ASEANcProfit before taxdTotal fixed assetseNumber of employeesfOperating costs- Salaries and benefits- Cost of sales- Financial costsNote: Data must be converted to United States Dollar Equivalent applying the exchange rate at the end of each particular fiscal year. (v) Please indicate if the financial statements are audited: %Yes % No If financial statements are audited, please enclose a set of the audited statements (vi) State the geographical presence of the organization (manufacturing and project sites, sales offices, wholly-owned subsidiaries, etc.) of the organization (country & city) ___________________________________________________________________ (vii) Please indicate if the nominated organisation has been subjected to any investigation or litigation: %Yes % No If the nominated organisation has been subjected to investigation or litigation, please provide brief details (You may enclose the details as a separate sheet) ____________________________________________________________________ SECTION 4: REFERENCES  Please provide below the professional advisors who have assisted the nominated organisation in its enterprise efforts. (a) BankBankerBankTel:Email:  (b) Audit FirmAuditorAudit FirmTel:Email:  (c) Other AdvisorNameFirmTel:Email:  (d) Other AdvisorNameFirmTel:Email:  SECTION 5: DECLARATION  To be completed only by the Chief Executive Officer / Managing Director / Chief Financial Officer or equivalent) of the organisation nominated for this Awards: I hereby declare that the facts stated in this application together with the accompanying information are true and correct, to the best of my knowledge, and satisfy the eligibility criteria. I understand that the financial information provided will be used strictly by the panel of judges in the judging process and not for public release unless I agree to its release. I further authorize the use and public release, in connection with the ASEAN Business Awards, of organisations name, non-financial information, photographs, video and audio recordings from any source. I agree that no compensation shall be due to me or my organisation for such usage. 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