Date 2 Name Awarded by Date 3 Award Name Awarded by Date 4 Other SECTION 4: DIGITAL IMAGES Please Submit up to five high resolution digital images of the nominated organisation with the nomination (e.g. staff, manufacturing processes, building front, products etc.) Please submit a digital file of the organisation’s logo with the nomination (eps format) DECLARATION BY NOMINATOR The nominating entity, as a condition of recommending the above company, confirms it has satisfied itself that neither the company nor its subsidiaries have been convicted of breach of WorkCover, Trade Practices Act, Environmental Protection Act, Equal Opportunity Act or other State or Federal laws within the previous 12 months or if convicted have not had imposed on any of them a penalty of more than $10,000 for any such breach. The nominating entity has satisfied itself that the nominated company and its subsidiaries has a strong financial record. I hereby declare that the information provided in this nomination is correct at the time of submission and that the company I have nominated is located in Victoria, Australia and is an established manufacturing plant or provides design services to Victorian manufacturers. Signature Name in full Title Organisation Phone
Date 2 Name Awarded by Date 3 Award Name Awarded by Date 4 Other SECTION 4: DIGITAL IMAGES Please Submit up to five high resolution digital images of the nominated organisation with the nomination (e.g. staff, manufacturing processes, building front, products etc.) Please submit a digital file of the organisation’s logo with the nomination (eps format) DECLARATION BY NOMINATOR The nominating entity, as a condition of recommending the above company, confirms it has satisfied itself that neither the company nor its subsidiaries have been convicted of breach of WorkCover, Trade Practices Act, Environmental Protection Act, Equal Opportunity Act or other State or Federal laws within the previous 12 months or if convicted have not had imposed on any of them a penalty of more than $10,000 for any such breach. The nominating entity has satisfied itself that the nominated company and its subsidiaries has a strong financial record. I hereby declare that the information provided in this nomination is correct at the time of submission and that the company I have nominated is located in Victoria, Australia and is an established manufacturing plant or provides design services to Victorian manufacturers. Signature Name in full Title Organisation Phone