EY Business Journalism Awards Official entry form 2015

[Applicant name]

InstructionsThis form has been created in Microsoft Word and

the format is protected. All applications are

required to be submitted in this format using this

form as a base document.

Entry formPlease complete this form and email it, along with a copy of the story you are entering to jenni.mcmanus@nz.ey.com no later than 5.00pm Thursday 30 April 2015.

Personal details

Name ________________________________________________________________

Email _________________________________________________________________

Mobile ____________________________________________________________

Entry details

Please indicate the category in which you would like to be considered

Best business news story (print, online or multimedia)

Best young journalist(Up to three years’ journalism experience* )

Best business feature (print, online or multimedia)

Best radio or television business reporting

Best business editorial or commentary (print or online)

Name of publication ___________________________________________________

Story headline ________________________________________________________

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Date of publication ____________________________________________________

Cover letter (max 300 words)

*See attitional declaration on page 5

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Authority to use information

I acknowledge that:• The information contained in this form constitutes my initial application and

I may be required to provide additional information.• The judges may take any factors that they consider relevant into account in

reaching a decision. The judges’ decision will be final and no further correspondence will be entered into.

• EY may (at its sole discretion) withdraw an applicant from consideration at any stage of the selection process.

Please acknowledge that you understand and agree to the above. Yes No

Personal informationThe Privacy Act 1993 applies to any personal information that we collect from you.• Your personal information is collected by EY. Our contact details are set out below.• The use and disclosure of your personal information by EY will be in accordance

with the “use of information provided” as set out below.• If you do not provide your personal information to us, you will not be eligible to

enter the award.

Use of information provided• The information I provide will be used by EY and the independent judging

panel for purposes connected with the administration of the EY Business Journalism Awards (including promotion and judging the award).

• I hereby authorise the use and public release in connection with the EY Business Journalism Awards of my name, photographs and video recordings of me from whatever source.

Please confirm that you understand and agree with the above use of information (including personal) in respect to the promotion and administration of the EY Business Journalism Awards including events and publications.

Yes No

*See attitional declaration on page 5

Declaration of publicationI declare that:• The information I have provided in this form is true and correct.• All other information that I subsequently provide in connection with

the award will be true and correct.• I agree to use the name “EY” when referring to the award and to

otherwise co-operate with EY in promoting this award.• I have read and consent to the content of this declaration and

authority.

Applicant’s name Date

Signature Editors signature

Additional declarationBest young journalist category

I declare that at 5.00pm 30 April 2015 I have under 3 years’ journalism experience.

Applicant’s name Date

Signature

Key ContactsJenni McManusCommunications Manager

jenni.mcmanus@nz.ey.com+64 9 308 1087+64 21 971 599

*See attitional declaration on page 5

Thank you for your entry

EY

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© 2015 EY New ZealandAll rights reserved.

This material has been prepared for general informational purposes only and is not intended to be relied upon as accounting, tax, or other professional advice. Please refer to your advisors for specific advice.