Nomination Form for 2001 MAB Elections

1. All nominations for the 2001 MAB Elections must be made on this form.
2. Each nomination must be made on a separate form.
3. Only duly completed forms will be considered.
4. Completed forms should be submitted to the Medical Staff Secretary or to any of the members of the Nominations Committee, i.e. Dr. Ngun Kok Wah, Dr. Alan Teh Kee Hean or Dr. Dalina Abdul Majid.
5. The dateline for inclusion in the official ballot-paper is at 16:00 h on Wednesday, 20 June 2001.
6. Additional forms may be obtained from the Medical Staff Secretary.

 

 

Nomination

I, Datuk/Dato’/Dr. _________________________________ would like nominate
Datuk/Dato’/Dr. _________________________________ to stand for the 2001 Medical Advisory Board Elections.

 

Proposer:	Seconder:
Datuk/Dato’/Dr.:	Datuk/Dato’/Dr.:
Signature:	Signature:
Date:	Date:

 

 

Acceptance by Nominee

I, Datuk/Dato’/Dr. _________________________________ hereby accept this nomination as a candidate for the 2001 Medical Advisory Board Elections. In accordance with Section IV Clause J of the Bylaws of the Medical Staff of SJMC, I hereby further declare that I am fully aware of and understand the contents of the said clause, and that I know of no factors that may cause me to discharge my duties in the Medical Advisory Board of SJMC in a manner prejudicial to SJMC or its Medical Staff.

 

 

Signature: _________________________________        Date: _______________