BOARD OF DIRECTORS 2015 – 2017
NOMINATION FORM
NOMINATIONS CLOSE MARCH 20, 2015
Name of Candidate: _____________________
This information will be posted as a part of your candidate profile in the members only section of the
CCGI website. Please also submit your full Curriculum Vitae and an electronic photograph to be
posted with your profile.
Please complete this form:
PART 1: Nominee Statement
Please answer the following questions in 250 words or less.
How does serving on the Caribbean Corporate Governance Institute fit with your values and
commitment to creating better companies and efficient markets through Corporate Governance?
250 words or less
What do you think is the greatest challenge facing the Caribbean Corporate Governance Institute
as it works to advance its mission?
250 words or less
DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman),
Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde
REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected]
PART 2: Board Competencies
The competencies required by the Caribbean Corporate Governance Board include combinations and
variations of the following:
• Experience on Corporate Boards
• Financial Management
• Entrepreneurial Leadership
• Fundraising
• International Trends in Corporate Governance
• Financial Markets
• Caribbean Corporate Law
• Accountancy and Audit
• Strategic Planning
• Caribbean countries (focus is on the 20 Countries that form part of CARICOM)
• State Owned Enterprises
• Closely Held Companies (including Family Business)
• Listed and Regulated Companies
• Corporate Governance Education
• Corporate Governance Codes and Guidelines
• Sector specific Corporate Governance
Please note your areas of strength related to these competencies:
150 words or less
Please note any relevant professional designations or qualifications:
150 words or less
DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman),
Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde
REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected]
PART 3: Board, Work, Leadership and Life Experience
Board Experience - Please list your present or prior board experience:
Name of Organization
From (date)
To (date)
Position(s) on Board
Work and Leadership Experience - Please list your relevant work and leadership experience. Please
also attach your Curriculum Vitae as a Word or PDF file.
Name of Organization
From (date)
To (date)
Accomplishments
Life Experience – CCGI is committed to equity, diversity and inclusiveness. Please provide any
information on your background and life experience that you think may be of assistance to members as
they consider issues of diversity and inclusiveness in electing a new Board.
Life Experience:
150 words or less
Country Experience – CCGI is committed to serving members in the following countries. In which
countries have you have work experience in?
Anguila
Belize
Dominica
Jamaica
Antigua and
Barbuda
The
Bahamas
Barbados
Bermuda
Grenada
Montserrat
British Virgin
Islands
Cayman Islands
Guyana
Saint Kitts and
Nevis
Saint Lucia
Haiti
Saint Vincent and the
Grenadines
Suriname
Trinidad and Tobago
Turks & Caicos Islands
DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman),
Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde
REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected]
PART 4: Nominee’s Consent and Declaration
I hereby declare the information submitted in support of this nomination is accurate and true. I consent to
my nomination to the Board of Directors and consent to the Caribbean Corporate Governance Institute
conducting the necessary background checks and that any omission to the process would disqualify my
nomination. I consent to the posting of the information provided above, my photograph and Curriculum
Vitae on the CCGI website members only section for the purposes of this election. I have read all
attached material, and understand the commitment required to fulfill the position and agree to abide by
the CCGI’s Bye-laws, the Board’s Governance Policies and Election Protocol.
I affirm that I am:








a member in good standing with CCGI
compliant with CCGI’s code of conduct.
currently a senior executive or director of an enterprise
prepared to dedicate at least 2 days per month to CCGI activities throughout my term. This will
include Board meetings, special meetings, committee meetings, and other events that may come
up from time to time
prepared to be an ambassador for good governance practice in the Caribbean
willing to represent CCGI’s position before government officials and to members of the media, if
called upon to do so
willing to provide company/industry input and would contribute to written positions being put
forward from CCGI as required
prepared to invest in my governance education through self-funded participation in at least one
international conference or the CCGI’s director education programme during my term of office.
Name of Nominee: ________________________
Nominee’s Signature: ______________________
Date: ____________________________________
Please send a photo that can be posted on CCGI Members’ only section of the Website.
The Nominee Profile may be submitted separately from the Nominations Form;
Please ensure that both the Nominee Profile and the Nominations Form are submitted before the
deadline.
Please complete and return the forms no later than March 20, 2015 by email to:
Email: [email protected]
For more information on Elections Protocol, please contact us at [email protected]
DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman),
Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde
REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected]