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______________________________________________________________________

NOMINATION FORM: 2019

(Please note all the information requested in this form is compulsory) 1. Nominee information:

Name of nominee (Mr/Ms//Dr/Prof/Adv.): ___________________________________________

Age of nominee: ______________________________________________________________

Contact of nominee or family member (for posthumous Award):

Tel: _____________________________ Cell: ______________________________________

Email: _______________________________________________________________________

Postal or physical address: ______________________________________________________

____________________________________________________________________________

2 (a) Submission information, for all categories except Literary Translators Award:

Title of book/publication: ________________________________________________________

Year of publication _______________________ Language:_____________________________

Category nominated for (see the criteria of categories in the submission form):

____________________________________________________________________________

2 (b) Submission information for Literary Translators Award:

Title of original book/publication: _________________________________________________

Year of publication _______________________ Language:_____________________________

(2)

Title of the translated book/publication: ____________________________________________

Year of publication _______________________ Language:_____________________________

Category nominated for (see the criteria of categories in the submission form):

____________________________________________________________________________

Motivation to support the nomination (please also submit profile of author)

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

3 Details of nominator

Name: ______________________________________________________________________

Contact numbers: Tel: _________________________ Cell: ____________________________

E-mail: ______________________________________________________________________

Signature (Nominator): _________________________ Date:____________________________

4 Endorsement:

I ______________________________________________ the publisher/author

Accepts/endorses the nomination by/for ___________________________________ (the nominator/author) and confirm that the work submitted is my/the original work/published by/us ____________________________________________________________________________

Signature: _______________________________________ Date: _______________________

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5 Declaration:

I/we _________________________________________________ (the author/publisher)

declare that should any matter pertaining plagiarism arise around the work submitted, I/we shall take full responsibility to respond and deal with the matter until its finality and confirm that the South African Literary Awards cannot be held liable in this regard.

Signature: _______________________________________ Date: _______________________

6 Submissions must be sent to:

Physical address:

The South African Literary Awards, 74 Mimosa Road, Randpark Ridge, 2125

Postal address:

The South African Literary Awards P.O. Box 1465, Randpark Ridge, 2156

For enquiries:

060 509 5857

[email protected]

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