Vigil India Movement – Bangalore
M.A. THOMAS NATIONAL HUMAN RIGHTS AWARD 2016
Nomination Form
Nominee:
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Name
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Sex
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Age / Date of Birth
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Address
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Telephone
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Email
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Please state the organization (if any) to which the nominee is affiliated and the nominee’s position in the organization
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Name of the Organization
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Address
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Web address
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Email
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Reasons for nomination (to be written in a separate sheet)
Ø Please justify your nomination by describing clearly the nominee’s contribution towards the protection and promotion of human rights in
Ø Please include a brief resume of the nominee.
Ø Please attach any reference material in connection with the above that you may have.
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Nominator
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Name
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Profession
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Address
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Telephone
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Email
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For Office Use Only
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