Your details

Name(*)

Invalid Input

E-mail address:(*)

Invalid Input

Are you a Nomination Representative of an AFRINC Member?(*)

Yes No Please fill in all required fields correctly before submitting the form.

If yes, what is the name of the Member you are a Nomination Representative for?

Invalid Input

Nominee details

Full name of nominee:(*)

Invalid Input

Date of Birth:(*)

-- Please enter a valid date of birth. You must be at least 18 years old

Sex:(*)

Invalid Input

Nationality(*)

Invalid Input

Country of Residence(*)

Invalid Input

Physical address(*)

Invalid Input

Organisation (or affiliation)(*)

Invalid Input

Position(*)

Invalid Input

E-mail address:(*)

Invalid Input

Contact phone number (include country code)(*)

Invalid Input

Nomination information

Is this a nomination for a region-independent seat? (*)

Yes No Invalid Input

Sub-region nominated for(*)

Invalid Input

Brief Motivation of the Nominee (max 1500 characters): (*)

0/1500

Invalid Input

Professional Background of the Nominee (max 3000 characters): (*)

0/3000

Invalid Input

Please upload a copy of the Nominee’s CV:

Invalid Input

Please upload a current or recent photo of the Nominee:(*)

Invalid Input

Please upload a form of identification from the Nominee (e.g., a passport, driver’s licence etc.): (*)

Invalid Input

If YES please explain why?(*)

Invalid Input

Seconder details

Notice:

Nomination Representatives do not need to fill out this section.
For Self-Nominations or Nominations by those other than Nomination Representatives, please provide details of two seconders who must be Nomination Representatives of AFRINIC Members.

Seconder 1

Name:(*)

Invalid Input

Organisation(*)

Invalid Input

Position(*)

Invalid Input

E-mail address(*)

Invalid Input

Contact phone number (include country code):(*)

Invalid Input

Seconder 2

Name:(*)

Invalid Input

Organisation(*)

Invalid Input

Position(*)

Invalid Input

E-mail address(*)

Invalid Input

Contact phone number (include country code)(*)

Invalid Input

Statement of truth

I declare that, to the best of my knowledge and belief, that the information provided in this nomination form is true.

Invalid Input

THE DECLARATION FORM

FOR THE 2025 ELECTION

OF AFRINIC’S BOARD OF DIRECTORS

I declare that:
1. I am at least 18 years of age.
2. I am a natural person.
3. I have not been adjudged to be of unsound mind.
4. I am not an undischarged bankrupt.
I declare that I have not been convicted or serving a prison sentence in prison, in the five years prior to 23 June 2025, in any jurisdiction, of an offence:
1. in connection with the promotion, formation or management of a company;
2. involving fraud or dishonesty punishable with imprisonment for 3 months or more; or
3. of acting in breach of any statutory duty to exercise care, diligence and skill as a Director of any company.
I declare that I have not been convicted, in the five years prior to 23 June 2025 of an offence:
1. under section 332, 333, 334, or 335 of the Companies Act 2001 (Mauritius);
2. under section 46 of the Stock Exchange Act (Mauritius) as an insider;
3. under Part IX of the Securities Act 2005 (Mauritius), or;
4. under Mauritian law involving dishonesty.
I declare that I have not been prohibited from being a director, promoter, or being concerned in taking part in the management of a company by an order made under s.338 of the Companies Act 2001 (Mauritius) which will still be current as at 23 June 2025.
I am willing to be appointed as a director in the event of my being elected a Director, and to sign the forms required to be a Registered Member of AFRINIC in the event of my being elected.
I understand that the Nomination Committee may refuse to approve me as a candidate if I submit a false or misleading application.

Confirm Declaration(*)

I confirm that all of the above are correct

Please validate

Invalid Input