NOMINATION PAPER

To: The Returning Officer

Pharmaceutical Society of Ireland
PSI House
Fenian Street
Dublin 2, DO2 TD72

NOMINATION TO SEEK APPOINTMENT AS PHARMACIST MEMBER TO THE

COUNCIL OF THE PHARMACEUTICAL SOCIETY OF IRELAND
A: FOR THE NOMINATORS TO COMPLETE
We, the undersigned PSI registered pharmacists, holding current certificates of registration as pharmacists with
the PSI, hereby nominate:

First name(s): Surname:

Registration No:

Address:

with her/his consent, as a pharmacist candidate, in the 2019 election for appointment to the Council of
the Pharmaceutical Society of Ireland, subject to approval by the Minister for Health, in accordance with
the provisions of Section 10 of the Pharmacy Act 2007.

PROPOSER: Name: Reg No:

Signature:

Address:

SECONDER: Name: Reg No:

Address:

Signature:

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B: FOR THE NOMINEE TO COMPLETE

I,

being a registered pharmacist with the Pharmaceutical Society of Ireland, and holding a current
certificate of registration as a pharmacist with the PSI, hereby consent to the above nomination and
declare that:

(i) having regard to paragraphs (2)1 and (8)2 of Schedule 1 to the Pharmacy Act 2007, I am eligible
to stand for election for appointment to the Council,
(ii) in the event of not being elected, I am aware that my name may be placed on a panel with a
view to selection in the manner provided for under Rules 9(2) and 9(3) 3 and Part 3 (of the said
rules) for the filling of any vacancies or casual vacancies as may arise on the Council, and
(iii) in the event of being elected and appointed to the Council, I will, to the best of my abilities,
serve on the Council and abide by any Code of Conduct for members of the Council as may be
adopted by the Council from time to time.

Signature of candidate:

PRINT name of candidate:

Please state your primary area of professional practice as a pharmacist

(i.e. community, hospital, academia, industry or other). This information will appear alongside published
candidate information and on the ballot paper):

Date: 2019

THE NOMINATION PAPER OF A CANDIDATE MUST BE IN THE HANDS OF THE RETURNING OFFICER NO LATER THAN 12 NOON
ON WEDNESDAY, 20TH MARCH 2019, (i.e. 28 DAYS BEFORE THE DATE OF THE ELECTION WHICH IS ON
WEDNESDAY, 17th APRIL 2019), AND IS SUBJECT TO VALIDATION.

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1. Disqualification on grounds of bankruptcy, making an arrangement with creditors, conviction of any indictable
offence, conviction of offence involving fraud or dishonesty, being the subject of an order under sections 838, 842 and
850 of the Companies Act 2014, or being sentenced to a term of imprisonment.
2. Disqualification on grounds of membership (or of being a nominee) of either House of the Oireachtas or of the
European Parliament, or of being an employee of the Pharmaceutical Society of Ireland.
3. To be eligible to be placed on a panel in the event that an election occurs, the candidate will meet the criteria
outlined in Rule 14 of the PSI (Council) Rules 2008 and 2015.
FOR OFFICE USE

Received at the hour of: on the day of 2019

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Appendix 1
FOR USE IN THE EVENT OF AN ELECTION – BIOGRAPHY FOR PUBLICATION

If there are more nominations than vacancies available on the PSI Council, an election will be
called. For the purpose of informing the electorate (registered pharmacists) about you, you may
wish to outline, in not more than 300 words, relevant biographical information and state why
you wish to be appointed to serve on the PSI Council. This is not a mandatory requirement; any
biographies provided will be made available on the PSI website.