Nomination Form for 2023 IBA Independent Director Elections

Application form for IBA 2023 elections - Independent Director

Step 1 of 5

Nomination Form for 2023 IBA Independent Director Elections

To: Muhammed Emin ÖZKURT, Chair Nominations Committee International Boxing Association

Full Name(Required)

First Last

Citizenship(Required)

Gender(Required)

DOB(Required)

National Federation(Required)

Full address of residence(Required)

Street Address City ZIP / Postal Code Country

Phone number(Required)

Email address(Required)

Current position in boxing (if any)

With reference to the IBA Constitution, the IBA Disciplinary and Ethics Code and the IBA Conflicts of Interest Policy, I declare that:

I do not have and do not anticipate having any conflict of interests (actual, potential or perceived), even if I am elected / appointed to any position for which I am a candidate, except as disclosed below(Required)

I confirm

I agree to make immediate disclosure of any additional, actual, potential or perceived conflict of interests that may arise subsequent to the preparation of this declaration, by way of a separate declaration(Required)

I confirm

I am aware that a failure to declare a situation of potential conflict of interests may lead to measures and sanctions as per the IBA Disciplinary and Ethics Code(Required)

I confirm

I am aware that a failure to deal with any potential or actual conflict of interests may result in a decision of ineligibility of the concerned candidate(Required)

I confirm

Declaration of conflict of interest (actual, potential or perceived)

If your answer is “none” or “not applicable”, please enter that on the form.

Positions held in boxing:(Required)

Current jobs/paid positions:(Required)

Significant financial or other interests in the following:(Required)

Other facts that may give rise to may constitute actual, apparent or potential conflicts of interest:(Required)

If a close member of the family of the candidate (partner, children, mother/father, etc) is in a situation requiring a disclosure as per the above, please answer the questions below. By filling this form, the candidate confirms that the concerned member of his family has expressly agreed to such disclosure.

Name of the family member and link with the candidate:(Required)

Declaration of conflict of interests:(Required)

Additional comments concerning any of the above statements (optional):

Please attach signed Conflict of interest declaration form(Required)

Accepted file types: pdf, Max. file size: 100 MB.

Conflict of interest declaration form

I am aware that this Form will be submitted to the IBA Head Office, the BIIU Nomination Unit, the Independent Vetting Firm and, possibly, the BIIU Tribunal(Required)

I confirm

In accordance with article 16.3 of the IBA Regulations on Congress and Elections, the following mandatory exhibits shall be attached to this form. Please note that exhibits under letters (g) and (h) needs to be drafted in English or accompanied with a certified translation; exhibits under letters (d) to (f) may be drafted in Arabic, English, French, Russian and Spanish or accompanied by a certified English translation if drafted in another language.

A. A nomination form signed by the National Federation of the country of which the Candidate is a citizen, or alternatively by the Confederation of the same continent as her country of citizenship in accordance with article 27.2 of the IBA Constitution. These forms can be downloaded in the links below, then printed, signed and uploaded using the following button)(Required)

Max. file size: 100 MB.

Nomination Form - National Federation
Nomination Form - Confederation

B. A copy of the Candidate’s passport(s)(Required)

Max. file size: 100 MB.

C. A proof of place of residence / official domicile / or alternatively a proof of tax residence(Required)

Max. file size: 100 MB.

If it is impossible to produce this document for reasonable reasons, such as inexistence of registry, or material impossibility to get excerpt of the registry in a reasonable deadline due to administration failures in a given country, a self-declaration may be filed, together with a detailed explanation about why the required document is not available and any other evidence fit to have the same purpose as the missing document. This declaration must be countersigned by the National Federation of the Candidate, confirming the accuracy of the Candidate’s statements in this respect.

D. A copy of the official register of criminal records or any similar official document issued by the competent authority of all Candidate’s places of domicile for the last five years before the date of the application form(Required)

Max. file size: 100 MB.

E. A copy of the official register of debt collection or of debtors or of any other official register showing that the Candidate is not insolvent or bankrupt(Required)

Max. file size: 100 MB.

F. A detailed curriculum vitae or biography drafted in English, with the supporting documentation(Required)

Max. file size: 100 MB.

G. Any further supporting document or material deemed useful by the Candidate to show that she fulfills the eligibility criteria listed in article 27 of the IBA Constitution and has specific skills, experience, qualities and knowledge supporting her selection in accordance with article 26 of the IBA Constitution. Such documents should be drafted in English, or accompanied with a certified English translation

Max. file size: 100 MB.

I have taken due note and agree that incomplete applications will not be accepted, notably if mandatory exhibits are missing.(Required)

I confirm

DATA PROTECTION(Required)

I agree

I acknowledge and agree that IBA and the BIIU Nomination Unit, and any third parties contracted by them, may collect, store, process, use and disclose to third parties any personal information related to me and my candidature including, but not limited to my name, date of birth, contact details, image, data included in the exhibits to this Nomination Form and any relevant data about me and my curriculum vitae, to the extent necessary or helpful to the appointment of members of the corporate governance committees, and the fulfilment of the mandate as members of such committee. IBA and the BIIU Nomination Unit may create and update my personal data in any other way in which I have provided or will provide my express consent or as may be required by law.

I am aware that I can ask to have access to any of my personal data and that I am entitled to request their rectification to correspond to the truth. I have been duly informed and understand that IBA and the BIIU Nomination Unit may disclose personal information to third parties where such disclosures are required by law, informational purposes or deemed otherwise necessary. I am also entitled to object and refuse at any time the processing of my personal data as described above, by written and signed communication sent to IBA, bearing in mind that such refusal may affect my eligibility as a member of a corporate governance committee. I can request that all my personal data collected by IBA and the BIIU Nomination Unit, be erased, notably if and when such personal information is no longer relevant.

I am aware that this Form will be submitted to the IBA Head Office, the BIIU Nomination Unit and the Independent Vetting Firm to review if I meet all eligibility criteria

Comments

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Application form for IBA 2023 elections - Independent Director