SIGNED:

TITLE: DATE:

APPLICATION FORM

COMPANY NAME:

ADDRESS:

TEL: WEB:

EMAIL:

MANAGING DIRECTOR / CHIEF EXECUTIVE:

NAME OF CONTACT IN COMPANY WITH REGARD TO ADMINISTRATION OF THE AWARD:

COMPANY DETAILS:

APPLICANT COMPANY FIGURES FOR THE PAST THREE YEARS:FINANCIAL YEAR END

No. of EMPLOYEES

EXPORT SALES ‘000

TOTAL ANNUAL TURNOVER ‘000

BALANCE SHEET ‘000

/ / 2014 / / 2013 / / 2012

WE HEREBY CERTIFY THAT ALL THE PARTICULARS SUPPLIED BY US IN THIS ENTRY ARE CORRECT TO THE BEST OF OUR KNOWLEDGE AND WE AGREE TO ABIDE BY THE DECISION OF THE JUDGING PANEL ON ALL MATTERS RELATING TO THESE AWARDS

PROUDLY SPONSORED BY:

VICKI CAPLINIRISH EXPORTERS ASSOCIATION, 28 MERRION SQUARE, DUBLIN 2, PHONE: 01 642 4174ALL APPLICATIONS TREATED IN THE STRICTEST CONFIDENCE

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YEAR COMPANY WAS ESTABLISHED:

LIST YOUR MAIN EXPORT MARKETS AND THE TOTAL NUMBER OF COUNTRIES TO WHICH YOU EXPORT:

PERCENTAGE OF SALES REVENUE ACCOUNTED FOR BY EXPORTS:

IS YOUR OVERSEAS MARKETING CONTROL WITHIN IRELAND?

BRIEF DESCRIPTION OF NOMINATED COMPANY / PRINCIPAL PRODUCTS / SERVICES: (PLEASE ATTACH A BRIEF MEMO)

LIST OF KEY FACTORS WHY THE NOMINATED COMPANY / PRINCIPAL PRODUCTS / SERVICES SHOULD BE SELECTED FOR AN AWARD: (PLEASE ATTACH A BRIEF MEMO)

LIST THE KEY OBSTICLES TO EXPANDING YOUR BUSINESS: (PLEASE ATTACH A BRIEF MEMO)

CATEGORY:

ADDITIONAL INFORMATION:

PLEASE TICK WHICH CATEGORY YOU WISH TO ENTER.COMPLETE AN APPLICATION FORM FOR EACH CATEGORY.YOU MAY ENTER MORE THAN ONE CATEGORY.

A HIGH GROWTH MARKETS EXPORTER OF THE YEARSPONSORED BY ENTERPRISE IRELAND G LOGISTICS COMPANY OF THE YEAR

SPONSORED BY ROSSLARE EUROPORT

BHIGH POTENTIAL EXPORTER AWARD(For Enterprise Ireland Clients)SPONSORED BY ENTERPRISE IRELAND

HLIFE SCIENCES EXPORTER OF THE YEARSPONSORED BY KUEHNE + NAGEL

C SERVICES EXPORTER OF THE YEAR SPONSORED BY ENTERPRISE IRELAND I ICT EXPORTER OF THE YEAR

SPONSORSHIP AVAILABLE

D MULTINATIONAL EXPORTER OF THE YEAR SPONSORED BY HSBC J FOOD AND DRINK EXPORTER OF THE YEAR

SPONSORED BY BORD BIA

EMEDIUM SIZE EXPORTER OF THE YEARSPONSORED BY GUARANTEED IRISH K

BEST EXPORT EMPLOYERSPONSORSHIP AVAILABLE

F EMERGING SMALL EXPORTER OF THE YEARSPONSORED BY LOCAL ENTERPRISE OFFICE L

MARITIME SERVICES COMPANY OF THE YEARSPONSORSHIP AVAILABLE

YES NO

PROUDLY SPONSORED BY:

VICKI CAPLINIRISH EXPORTERS ASSOCIATION, 28 MERRION SQUARE, DUBLIN 2, PHONE: 01 642 4174ALL APPLICATIONS TREATED IN THE STRICTEST CONFIDENCE

RETURN TO: