Application form for IBA 2023 elections - Independent Director Step 1 of 5 20% Nomination Form for 2023 IBA Independent Director ElectionsTo: 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone number(Required)Email address(Required) I would like to submit my candidacy for the following position:(Required) IBA Independent DirectorI hereby confirm that I have read, understood and agree to be bound by and comply with the lBA Constitution, the IBA Regulations on Congress and Elections, the IBA Disciplinary and Ethics Code including its article 47, and any other relevant regulations.(Required) I confirmI confirm that I agree to be bound by any decisions taken by the BIIU Nomination Unit with respect to my eligibility and my selection amongst the candidates for the positions of Independent Directors.(Required) I confirmWith reference to article 27.2 of the Constitution, I have been duly nominated for election by (please tick as appropriate):(Required) A National Federation A Confederation Name of National Federation(Required) Name of Confederation(Required) I hereby declare that I fulfil all eligibility requirements listed under articles 27.7 and 27.8 of the IBA Constitution. I have taken due note that I will be eligible only if I successfully pass an integrity check as summarised below(Required) I declare- The BIIU Nomination Unit with the support of the Independent Vetting Firm shall conduct an integrity check of all candidates to ensure that each candidate: (a) meets the high standards of conduct, reputation and integrity required of a Director; (b) has been and is in full compliance with the IBA Conflict of Interest Policy and is free of any actual major Conflict of Interest; (c) does not hold any position in any international boxing organization other than IBA or a Confederation, which could be prejudicial to his position as member of a corporate governance committee or could cause a Conflict of Interest. - The criteria to be used to assess if a candidate meets the criteria listed above shall include, without limitation, whether the person: (a) is or has been convicted of a criminal offence, is or has been sanctioned for a breach of the Constitution, the Regulations, the IOC’s Code of Ethics, anti-doping regulations adopted pursuant to the World Anti-Doping Code or any of its national derivatives, or is the subject of a current or pending prosecution or proceedings for the commission of such an offence or breach, provided however that such conviction or sanction is likely to result in adverse findings being made about the person’s credibility, integrity, honesty or reputation; (b) is or has been a bankrupt or otherwise insolvent under the law of the candidate’s place of domicile; (c) is barred from conducting business in any country worldwide; (d) has his/ her credibility, integrity, honesty or reputation undermined or having been brought into disrepute, resulting in the risk that his or her association with IBA, or continued association, has or is likely to affect the reputation or the interests of the sport of boxing or of IBA; or (e) is unwilling or unable to deal with any potential or actual Conflict of Interest.Convictions and/or sanctionsAny candidate, who has been convicted of a criminal offence, or has been sanctioned for a breach of sporting regulations or is the subject of a pending investigation for such an offence or a breach is invited to provide all relevant information about such cases (including offence, date, sanction, etc) and explain why such conviction or sanction would in his or her view not result in adverse findings being made about the person’s credibility, integrity, honesty or reputation.I have taken due note of the limitation in the number of terms of office as per IBA Constitution, as well as the “fresh start in leadership” criterion as described in the report issued by the Governance Reform Group (article 28.2 (a) IBA Regulations on Congress and Elections)(Required) I confirmFor the purpose of the above (please tick as appropriate):(Required) I have not reached the maximum number of terms of office I may have reached the maximum number of terms of office due to the partial term served, but I apply for the BIIU Nomination Unit to decide that this partial term shall not count as a term of office for the purpose of calculating the maximum number of terms of office. Please indicate the function Dates (start-end) Please list below all functions previously occupied within IBA / AIBA and/or a Confederation, indicating the dates and function:Year IBA / Confederation Function Year IBA / Confederation Function Year IBA / Confederation Function I have further taken due note of the procedure and formal requirements to become a candidate, as listed in articles 16 et seq of the IBA Regulations on Congress and Elections. I agree that any failure to comply with the formal requirements provided in the Regulations may result in a declaration of ineligibility.(Required) I confirmI am familiar with the selection process for Candidates for election as Independent Directors based on the “Skills Map”, as described in article 20 of the IBA Regulations on Congress and Elections. I agree to comply with any instructions that may be received from the BIIU Nomination Unit and/or the Independent Vetting Firm in the context of this selection process.(Required) I confirm MotivationWhat is your motivation to be on the Board of Directors of IBA?(Required)What are your goals during your term on the Board?(Required)What are your main strengths and what will you bring to the Board?(Required)Industry experienceBoxing(Required) No experience Some experience at national level Some experience at an international level Substantial experience at national level Substantial experience at international level Expert (national or international) e.g. a former boxer or administrator in a national or international boxing organisationOther Sports(Required) No experience Some experience at national level Some experience at an international level Substantial experience at national level Substantial experience at international level Expert (national or international) e.g. a former athlete in a sport other than boxing or an administrator in a sports organisationBusiness(Required) No experience Some experience at national level Some experience at an international level Substantial experience at national level Substantial experience at international level Expert (national or international) A background in any for-profit company in any industryNon-Profit Organisations(Required) No experience Some experience at national level Some experience at an international level Substantial experience at national level Substantial experience at international level Expert (national or international) A background in local, regional or national government workGovernment services (inc. law enforcement)(Required) No experience Some experience at national level Some experience at an international level Substantial experience at national level Substantial experience at international level Expert (national or international) A background in local, regional or national government workOtherPlease also comment hereIndustry knowledge and skillsSports governance and ecosystem(Required) None Basic Intermediate Advanced Expert e.g. knowledge of relationships between IOC and IBA (or other IFs), IBA and National Federations. Knowledge and experience of sports governance and/or sports dispute resolutionPlease provide any comment you deem relevantLegal/Regulatory/Compliance(Required) None Basic Intermediate Advanced Expert e.g. a qualified lawyer or experience in anti-corruption or experience in public or regulatory policy in sports or other industriesPlease provide any comment you deem relevantGovernment/Public Office(Required) None Basic Intermediate Advanced Expert e.g. ministries, secretary of state, state agenciesPlease provide any comment you deem relevantFinance/Accounting/Audit(Required) None Basic Intermediate Advanced Expert e.g. knowledge in financial accounting and reporting, corporate finance and internal financial controls, and financial risk and controlsPlease provide any comment you deem relevantMarketing/Communications/PR(Required) None Basic Intermediate Advanced Expert e.g. brand awareness and reputation, stakeholder communication, media relations, product strategiesPlease provide any comment you deem relevantCEO/CFO/COO/Senior Management(Required) None Basic Intermediate Advanced Expert e.g. experience of making major corporate and strategic decisions, implementing visions and leading or guiding other executives, risk managementPlease provide any comment you deem relevantMedical(Required) None Basic Intermediate Advanced Expert e.g., a qualified doctor or nurse, work in healthcare administrationPlease provide any comment you deem relevantCorporate Social Responsibility(Required) None Basic Intermediate Advanced Expert e.g. sustainability, monitoring and evaluation, work with non-profits, partnerships and eventsPlease provide any comment you deem relevantHuman Resources(Required) None Basic Intermediate Advanced Expert e.g. understanding of recruitment procedures, development of training or development programmes, disciplinary and grievance issuesPlease provide any comment you deem relevantOperations(Required) None Basic Intermediate Advanced Expert e.g. oversight of organisational activities of organisations (business, government or non-profit), coordination of departments, planningPlease provide any comment you deem relevantTechnology(Required) None Basic Intermediate Advanced Expert e.g. technology research and development, technology product sales, computingPlease provide any comment you deem relevantLanguages(Required) None Basic Intermediate Advanced Expert Please list all language skills and level of proficiencyPlease provide any comment you deem relevantPersonal attributesIn this section, you must evaluate your behavioural skills. Tick the box of the most appropriate response. You must be as honest as possible.I can communicate effectively and succinctly(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am self-aware(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I have high standards of personal integrity(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am always willing to challenge ideas and proposals(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am able to create strong interpersonal relationships(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am able to listen to others and understand the points they are trying to make(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am willing to devote a lot of time to being an Independent Director(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I have expectations of high ethical standards in others and I am willing to hold others to account(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am able to make evidence-based suggestions and counterproposals(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am willing to make difficult decisions in the best interests of IBA(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am willing to deal with any conflicts of interest that may arise(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree (see IBA Conflict of Interest Policy)I am willing to place the interests of the IBA above other professional or personal interests(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I will not derive any personal benefit as an Independent Director in a manner that contravenes the IBA Conflict of Interest Policy(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree (see especially article 22 on Gifts and Other Benefits)I take offence and find it disrespectful when others disagree with me(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I can adapt to changes quickly(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am committed to the purpose, mission, and values of the IBA(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am able to work as part of a team(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am able to come up with creative and innovative proposals(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree I am able to provide critical feedback in a constructive manner(Required) Strongly disagree Do not agree I don't have an opinion Agree Strongly agree 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 confirmI 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 confirmI 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 confirmI 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 confirmDeclaration 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.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.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.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.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 translationMax. 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 confirmDATA PROTECTION(Required) I agreeI 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 CommentsThis field is for validation purposes and should be left unchanged.