CONTACT DETAILS:

BUSINESS DETAILS

Academic & Professional Details

*Current Directorships Held

*Past Directorships Held

*Directorships Abroad

Please attach your updated CV and a JPEG or passport photo.

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SECTION C: VALIDATION

NB: Indicate your answer by ticking in the box

1. Have you ever been placed under curatorship?YesNo

2. Have you ever been a defendant, an accused or a respondent, either in your personal capacity or in a representative capacity, in a civil proceeding, regulatory- or tribunal enquiry, in a disciplinary proceeding, or other any other type of formalized enquiry relating to your personal of professional conduct?YesNo

3. Have you ever been seized, surrendered your estate, or in the case of an incorporated entity, have an order for the provisional winding-up of the Member been made?YesNo

4. Have you ever been a defendant or accused in a criminal proceeding?YesNo

5. Have you ever been removed, disqualified, or otherwise barred by a competent authority?YesNo

6. Have you ever been removed, disqualified, or otherwise barred by a competent authority, from serving in a position of trust such as a director, member, trustee, executor, or curator?YesNo

7. Are there any concluded, ongoing, potential, or pending actions or proceedings against you?YesNo

8. Are there any concluded, ongoing, potential, or pending actions or proceedings against you which, if you were an IoDZ member, may pose a reputational or other risk to the IoDZ?YesNo

9. Have you been refused registration or membership of any professional body, or have you had such registration or membership revoked, withdrawn, or terminated by any professional body as a result of your personal or professional conduct?YesNo

Code of conduct

As a member of the IoDZ, I commit:

And as an individual charged with governance duties in a company or organisation (s), I commit:-

1) To serve the best interest of the company or organisation with care, skill, diligence, and faith.
2) To be responsible for the actions and assets of the company or organisation and for keeping the company or organisation on a strategic path.
3) To be accountable to shareholders and other stakeholders for decisions and actions of the company or organisation.
4) To be fair to shareholders and other stakeholders of the company or organisation by considering the
legitimate interests of those who are affected by the organisation.
5) To be transparent by disclosing information that will enable shareholders and stakeholders to hold the company or organisation to account and that provides a holistic representation of the organisation’s past performance and its prospects for the future.
6) To comply with the law.
7) To uphold the reputation of the IoDZ.
8) To advance the IoDZ’ s objective of promoting sound governance and responsible directorship.

LIABILITIES

Any member who contravenes any provision of this code shall appear before a Judicial Committee of the IoDZ and if found guilty may face any of the following liabilities:

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SECTION D: DISCLAIMER

I hereby, apply for the Individual membership of the IoDZ and agree to be bound by its constitution, the code of conduct, rules and regulations.

Date
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SECTION E: CHECKLIST

NB: Indicate you have attached the following by ticking

Academic CertificatesYesNo
National Identification YesNo
Curriculum VitaeYesNo
Passport Size PhotoYesNo
Signature on Section A, Section B & Section DYesNo