Page 104 - The Official FIAP Book

EN 01-01-2019 page A

MFIAP
A DOSSIER FOR FIAP DISTINCTION

ADMINISTRATIVE DOSSIER

Distinction requested: MFIAP Year: Country:

Federation: Date:
UN Code:

Name and signature of the person responsible within the federation
By his signature the person responsible within the federation
confirms that the data given have been verified.

CANDIDATE

Complete name: Male:
(Name for the certificate) Female:

Surname: Given name(s):

Nationality: Date of birth (day/month/year):

Adress:
Postal code + city:
E-mail:
Number of the FIAP Photographer's Card: Number FP (Profile Number) :

Year EFIAP was obtained:

Title of the Portfolio:
Send the complet document (pages A, B and C) together with the digital files of the submitted works by WeTransfer to
fiapdistinctions@gmail.com
Send the pages A and B on paper by postal mail to Chris Discart - Hagenbroeksesteenweg 174 - B 2500 Lier - Belgium