Page 97 - The Official FIAP Book

EN 01-01-2019 page A

NFIAP - EFIAP/d8
A DOSSIER FOR FIAP DISTINCTION

ADMINISTRATIVE DOSSIER

Distinction requested: 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)
Automatic. Do not fill in >> Female:

Surname: Given name(s):

Date of birth (day/month/year):
Nationality: dd/mm/yyyy
Address:
Postal code + city:
E-mail:
Number of the FIAP Life Card: Number FP (Profile Number) :

LIST OF SUBMITTED WORKS

TITLE OF THE WORKS AWARD Nr FIAP COUNTRY
yyyy/xxx
yyyy/xxx

yyyy/xxx
yyyy/xxx
yyyy/xxx

Send completed document (pages A, B and C), together with the submitted works, electronically to the FIAP Liaison Officer in your country.
Complete page B. Print and sign the page and send a scan of this signed page to the FIAP Liaison Officer in your country.
Please follow your FIAP Liaison Officer’s instructions as to where and how these items are to be sent.