MyBrokers Ireland Awards 2019 Nomination Form
Nominator, Please fill in your details below

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:


Please select which category (s) you would like to enter your nominated employee in for? (you can select more than one category)

Personal Lines Broker of the Year
Commercial Lines Broker of the Year
Sales Team of the Year
Team Leader of the Year
Educational Achievement Award
Young Insurance Broker of the Year
Outstanding Achievement Award

Please enter (in box below) the name of the person/team you would like to nominate and also include the following:

- Name of Brokerage

- Position Held

- Address

- Phone Number

- Email

- Length of Service

- How long have you worked with nominee/team


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What are the principle responsibilities of the nominee/team?


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What skills does the nominee(s) exhibit that enables them to excel in their role? 


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What skills does the nominee(s) exhibit outside of their role?


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Please outline the principle reasons that prompted you to nominate this person/team for an award?


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Please provide any other relevant information not already captured that might enhance the quality of this submission (Optional)


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If available, please include brief comment (s) from fellow colleagues and/or owner/Manager on the quality of this candidate


1000 characters left.