2017/170591/07

INTERNATIONAL

APPLICATION FORM

MISS UNWORLDRegistered Name and Surname: ________________________________________________________________________________

Maiden Name: ________________________________________ I.D Number:___________________________________________

Weight: __________kg Height: ________________ Dress size: __________ Shoe Size: ____________ Age : ____________

Natural Eye Colour: _________________________________ Natural Hair Colour: ___________________________________

Physical Residential Address: ___________________________________________________________________________________

_____________________________________________________________________________________________________________________

Town/ Suburb :_______________________________________________________________ Code:_____________________________

Province: ____________________________________________ Country : _________________________________________________

Postal Address: __________________________________________________________________________________________________

Contact nos. (H) ______________________________________________ (W) ______________________________________________

Mobile: (+ __________)________________________________ e-mail : ____________________________________________________

Emergency no-(+ _________)_____________________________ e-mail : _________________________________________________

Qualification: (School) : __________________________________________________________________________________________

(Tertiary): _________________________________________________________________________________________

Applicants Current Occupation: __________________________________________________________________________________

(Initial Here) ………………………………………

Medical Condition: Clearly state condition, if on medication/treatment: Uniworld Pageants Reserves All Rights

________________________________________________________________________________________________________________________

Allergies: Are you allergic to any: ( Yes/No) Medication: ____________ Foods: ____________ Other_____________

If yes, clear state: __________________________________________________________________________________________________

List your interest/ Hobbies: _______________________________________________________________________________________

_______________________________________________________________________________________________________________________

Motivational Description of yourself: ____________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

Have you participated in any other pageants/competitions ? _________________________________________________

If YES, State name and year of participation & Titles /Awards Received:

______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

Have you been convicted of a crime/or involved in any? ______________________________________________________

( Note: Convicted includes after trail, as well as pleas of guilt or nolo contendere(no contest). If Yes, Please attach an explanation on a separate page.(Organizers discretion would determine success of application)

I hereby confirm the information supplied by myself is true and binding.

Name & Surname of Applicant: _________________________________________________________________________________

Signature of Applicant : ___________________________________________________ Date: ________________________________

Witness : Name & Surname(Print) ______________________________________________________________________________

Signature: ______________________________________________________________________________

Uniworld Pageants Reserves All Rights