Nomination Form

Nomination Form: Individual

Nominate an individual for Merdeka Award

Personal Information
* Compulsory fields
Full name of the individual you are nominating *
What is this person's age? *
Which category are you nominating the individual for? *
Share 3 reasons why you are nominating this individual. List the significance or impact that your nominee has created in a few sentences. *
Share links of pictures / information about the nominee’s most significant work(s) or impact achieved i.e. social media profiles, news coverage, published works, testimonials, awards or grants received, research papers, etc. *
Is your nominee aware of this submission? *
Kindly provide the contact details of the nominee (if available)
Nominee Phone Number (Mobile) *
Example: 6012-12345678
Nominee Phone Number (Office)
Example: 603-12345678
Nominee Email Address *
Example: name@mail.com
Your contact details for further information
Your Name *
Your Phone Number (Mobile)
Example: 6012-12345678
Your Email Address *
Example: name@mail.com
Your Phone Number (Office)
Example: 603-12345678
 
Would you like to receive email updates about Merdeka Award? *
PDPA Statement / Consent *
 

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