PDF《证件照片》

5 rankings could be listed. 排名日期 (日/月/年) Ranking Date (dd/mm/yyyy) 亚洲排名 Asian Ranking 比赛项目 Event (请填写中文及英文Please write in both Chinese and English) 成绩 Result 亚洲纪录 Asian Record 6. 打破香港纪录的次数及成绩 打破香港纪录的次数及成绩 打破香港纪录的次数及成绩 打破香港纪录的次数及成绩 (纪录必须获本港体育总会核实及认可.最多可填写五项纪录.) Number of times breaking the Hong Kong records and results (Records must be verified and recognized by NSA. Maximum

5 records could be listed.) 日期 (日/月/年) Date (dd/mm/yyyy) 国家 Country 比赛名称 Name of competition (请填写中文及英文Please write in both Chinese and English) 比赛项目 Event (请填写中文及英文Please write in both Chinese and English) 成绩及名次 Result& Position 7. 打破国际纪录的次数及成绩 打破国际纪录的次数及成绩 打破国际纪录的次数及成绩 打破国际纪录的次数及成绩 (纪录必须获国际/亚洲单项体育联会核实及认可.) Number of times breaking the international records and results (Records must be verified and recognized by IF/AF.) 日期 (日/月/年) Date (dd/mm/yyyy) 国家 Country 比赛名称 Name of Competition (请填写中文及英文Please write in both Chinese and English) 比赛获国际/亚洲单项 体育联会认可 Event Sanctioned By IF/AF *请填写国际/亚洲 *Please fill IF/AF 比赛项目 Event (请填写中文及英文Please write in both Chinese and English) 成绩及名次 Result & Position 8. 座右铭 座右铭 座右铭 座右铭 Motto (请填写中文及英文Please write in both Chinese and English) 座右铭 Motto 9. 其他资料 其他资料 其他资料 其他资料 Other information (请填写中文及英文Please write in both Chinese and English) 内容 Contents 声明 声明 声明 声明 本人保证提名表格# 内所提供或填写之资料均为真实、正确及完整,提名表格一经递交,所有已填报的资料不得所出任何更改或补充.本人明白审批委 员会 /评审团只会根崦砀裆纤峁┑淖柿献鞒錾笈/评审,主办单位将会提供参选者姓名、性别、年龄、照片及所属体育总会给予审批委员会、 评审团、传媒及公众作参考用途.本人同意,上述资料如有错漏引致本会所提名的运动员受到任何损失及不利因素影响,主办机构毋须负责. #提名表格会在整个选举完结后三个月被销毁. DECLARATION I hereby declare and certify that all information provided in the nomination form# is true, correct and complete. I understand that the Organizer shall have no obligation to take into consideration any subsequent amendments and supplemental information given after the submission of the nomination form. Any subsequent amendments or supplemental information supplied by the nominating NSA will not be entertained. I understand that the vetting committee/judging panel would vet/judge on and only on the information provided in the nomination form and that the name, sex, age, photo and the respective National Sports Association of nominee(s) will be given to the Vetting Committee, Judging Panel, Media and Public for reference purpose. We accept that the Organizer bears no responsibility for any loss and unfavorable factors caused to the nominees of my Association due to any errors or omissions in filling in the nomination forms. #This nomination form will be destroyed in

3 months after completion of the Awards.