ANNEXURE

1. Name of Architect Award to be considered for:

[Please give one name only. Name of other associated architects shall be given at sr. No. 7 (i)]

2. Name of firm/Organization represented:

3. Address:

TeI. Nos. Office:

Res.:
Fax:
E-mail:

4. Year of Birth:

5. Professional Qualification/Attainments:

6. Project Details:

(i) Project Name:

(ii) Location:
(iii) Client Name:
Address:

(iv)Year of Commencement:
(v) Year of Completion (Proof shall be enclosed):
(vi) Cost of Project:

7. Project Team:

(i) Associated Architect (s) :

(ii) Structural Engineer / Civil Design Engineer:
(iii) Consultant (s):
(vi) Any other:

8. Display Enclosures:

A. Drawings in coloured / black & white reproduction in A-3 size, without any mount
sheet.
(The name of applicant architect shall be written only on the backside of drawings).
No. of drawings enclosed____________ [Required Minm. 4 & Max. 6]
B. Coloured Photographs of the completed project in A-4 size, without any mount sheet.
(The name of applicant architect shall be written only on the back side of photographs.)
No. of photographs enclosed ____________ [Required Minm. 4 & Max. 6]

9. One page Bio-Data of the Architect: (As separate enclosure required.)

Declaration

I ________________________________ do hereby declare that all the foregoing information

is true to the best of my knowledge, and that I have designed and supervised the execution of
the Project as an individual / as head of the team which has worked on the Project.

I further declare that,

a. Entry project confirms to building bye-laws & development conditions applicable to the
site concerned where the project has been constructed.
b. No action is initiated / pending in the office of the Building plan sanctioning & completion
certifying authorities.
c. Project is completed during the last 5 years (calendar year: 2004- 2009)

(Signature & Seal)

Please send duly completed entry to:

Akshaya K.Beuria
Chairman,IIA,Orissa Chapter
Designers Forum
N-2/64,IRC Village
Bhubaneswar-751015
Tel:0674-2558056/2556266

For office use only:

Entry received on: Entry code: