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New Membership Application Form

This document contains an application form for membership to the Papua New Guinea Institute of Directors. It requests information such as the applicant's name, employer, contact details, current and past directorships, formal training, other professional memberships, criminal convictions, bankruptcy status, and nominations. It explains that applications will be considered by a membership committee and board and that entrance fees will be refunded if an application is refused.

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Isaac Thomas
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36 views

New Membership Application Form

This document contains an application form for membership to the Papua New Guinea Institute of Directors. It requests information such as the applicant's name, employer, contact details, current and past directorships, formal training, other professional memberships, criminal convictions, bankruptcy status, and nominations. It explains that applications will be considered by a membership committee and board and that entrance fees will be refunded if an application is refused.

Uploaded by

Isaac Thomas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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The Papua New Guinea Institute of Directors Inc.

PO Box 660, Port Moresby, NCD.


Phone: 320 2492 Direct Line: 320 0508
Mobile: 7663 2664/7836 7223
E-mail: [email protected] Website: www.pngid.org.pg
Location: Ground Floor, POD1 Factory, Munidubu Street,
Lawes Rd, Konedobu.

APPLICATION FOR MEMBERSHIP

Professional Member Associate


(*Please tick appropriate membership box*)

1. Name: Current Position:

2. Employer________________________ Business Address________________________

3. Business Telephone: Mobile: Gmail/E-mail:

4. Commencing with the most recent/current appointments, please provide details of your
current Directorships and Board appointments:

Name of Organisation Country Legal Structure Dates


(Private Co. - Pub. Co. - Inc. Assoc. - Trust From To
Statutory Body - Council - Landowner Grp)

5. Detail any formal training that you have had in the role, duties and responsibilities of being a
Director.

6. Membership of other professional bodies

The Papua New Guinea Institute of Directors – "Promoting Good Governance"


7. a) Have you ever been:

 Convicted of a criminal offence? YES NO

 Found guilty of misconduct in office (as defined under the Leadership Code?) YES NO

 Bankrupt or insolvent? YES N0

If you have answered ‘YES’ to any of the foregoing, please give details:
________________________________________________________________

________________________________________________________________

________________________________________________________________
8. Nominated and seconded by a current financial professional member of the PNG Institute of
Directors. (Print name and sign)

Nominated by: _________________________ Signature: ________________

Seconded by: _________________________ Signature: ________________

9. Declaration

To the best of my knowledge and belief the foregoing information is correct. I have read the
information provided and hereby apply for membership of the PNG Institute of Directors. I
agree that I will abide by the Institute’s Constitution and Rules of Association and the
Institute’s code of Professional and Ethical Conduct.

Signed: ……………………………………… Date: …………………………………

NOTE:

Applications are considered by the Membership Committee and recommendations presented to the Board.
Decisions on membership are advised in writing.

In its deliberations the Membership Committee may seek further clarification of information that you have provided. If
an application is refused, the entrance fee is refunded in full.

The Papua New Guinea Institute of Directors – "Promoting Good Governance"

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