Tanzania Chamber of Commerce,Industry and Agriculture

TANZANIA CHAMBER OF COMMERCE,
INDUSTRY AND AGRICULTURE
FOMU YA KUOMBA UONGOZI
(NOMINATION FORM)
IJAZWE NA MGOMBEA WA NAFASI YA UONGOZI TCCIA
To be completed by TCCIA leadership aspirant (Herufi kubwa au ichapwe/print)
PICHA
PHOTO
FORM No.1
EC-TCCIA/NATIONAL
A. TAARIFA BINAFSI(Personal Details):
1. NAFASI UNAYOGOMBEA
Post aspired for
2. JINA LA MGOMBEA KWA KIREFU
Name of aspirant in full
3. CHEO /DESIGNATION ______________________________________________
4. TAREHE NA MAHALI ULIPOZALIWA:
DATE OF BIRTH AND PLACE OF BIRTH
(Ambatanisha nakala ya aidha cheti cha kuzaliwa au Pasipoti au Kadi ya Mpiga Kura)
(Attach copy of either Birth Certificate or Passport or voter ID)
5 NAMBA YA SIMU
Telephone No.
6. BARUA PEPE
Email address
7. NAMBA YA FAX.
Fax No.
8. KIWANGO CHA ELIMU/TAALUMA
The academic achievement
Ambatanisha nakala ya vyeti
(Attach copy of Certificates)
9. TAJA KAMA UMEWAHI KUSHITAKIWA NA MAHAKAMA NA KUPATIKANA NA HATIA
State if you have been charged for criminal offence and convicted
TAJA KOSA NA ADHABU ULIYOPEWA
Mention offence and the sentence
B: TAARIFA ZA BIASHARA/SHUGHULI/BUSINESS PARTICULARS
10. WASIFU WA BIASHARA YAKO
Your Business profile
i. JINA LA KAMPUNI/BIASHARA:
Name of your Company/Business
ii. AINA YA BIASHARA:
Type of Business
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iii. NAMBA YA USAJILI WA KAMPUNI/BIASHARA (Ambatanisha Nakala)
Registration Number – Attach Copy
iv. LESENI YA BIASHARA (Ambatanisha Nakala):
Business License (Attach Copy)
v. TIN/VAT (Ambatanisha Nakala):
vi. RIPOTI YA MKAGUZI WA MAHESABU (Katika kipindi cha miaka miwili iliyopita)
Attached Copy of Audited Accounts for the past two years.
vii. MAHALI ILIPO BIASHARA/SHUGHULI
__________________________________________
C: TAARIFA ZA UANACHAMA (Membership status)
viii. JE NI MWANACHAMA HALALI WA TCCIA (Ambatanisha Nakala ya risiti kwa kipindi cha miwili iliyopita)
Valid Member of TCCIA – Attach copy of receipts for the past two years.
Ix. NAMBA NA TAREHE YA KUINGIA UANACHAMA WA TCCIA ____________________________________
Membership Registration Number and date
D: TAARIFA ZA UZOEFU WA UONGOZI/Biashara (Leadership Experience)
11. TAJA NAFASI ULIZOONGOZA KATIKA BIASHARA
State the posts that you have held in Business
12. (i) TOA HISTORIA YAKO KWA UFUPI KWENYE UONGOZI
Give your short background, in leadership
(unaweza kuongeza karatasi moja/ you may add one additional paper)
(ii) KAMA UKICHAGULIWA TAJA MIPANGO AU MTAZAMO WAKO KATIKA UONGOZI WA TCCIA
Give your plans or opinion on administration of TCCIA if you are elected
(unaweza kuongeza karatasi moja/ you may add one additional paper)
13. YAKINISHI /UTHIBITISHO
Nashuhudia/Nathibitisha kwamba yote niliyoeleza hapo juu ni kweli kabisa na ninaweza
kushitakiwa au kuwajibika Iwapo itadhihirika vinginevyo.
CERTIFICATION/CONFIRMATION
I hereby certify/Verify that all what I have stated above is true and I may be prosecuted or held
responsible if the above is proved otherwise.
SAHIHI YA MGOMBEA
Signature of aspirant
Mbele ya:
Before Me:
Mkurugenzi Mtendaji
Executive Director
Sahihi:
Muhuri
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KWA MATUMIZI YA OFISI TU
FOR OFFICE USE ONLY
14. ELEZA KAMA MGOMBEA AMETIMIZA MASHARTI
State if the aspirant has met the condition
15. ELEZA KAMA ANATEULIWA KUGOMBEA NA NAFASI GANI
State if he or she has been nominated and the respective post.
Mwenyekiti - Kamati ya Uchaguzi TCCIA
Chairman - TCCIA Elections Committee
Katibu- Kamati ya Uchaguzi TCCIA
Secretary - TCCIA Elections Committee
Sahihi
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