PIN NUMBER

1. Name of Practice / Team

2. Author of Design (Representative of Team)

Name

Job-Title

Country Your Country Andorra United Arab Emirates Afghanistan Antigua and Barbuda Anguilla AlbaniavArmenia Angola Antarctica Argentina American Samoa Austria Australia Aruba Åland Islands Azerbaijan Bosnia and Herzegovina Barbados Bangladesh Belgium Burkina Faso Bulgaria Bahrain Burundi Benin Saint Barthélemy Bermuda Brunei Darussalam Bolivia Bonaire, Sint Eustatius and Saba Brazil Bahamas Bhutan Bouvet Island Botswana Belarus Belize Canada Cocos Islands Congo, the Democratic Republic of the Central African Republic Congo Switzerland Côte d'Ivoire Cook Islands Chile Cameroon China Colombia Costa Rica Cuba Cabo Verde Curaçao Christmas Island Cyprus Czech Republic Germany Djibouti Denmark Dominica Dominican Republic Algeria Ecuador Estonia Egypt Western Sahara Eritrea Spain Ethiopia Finland Fiji Falkland Islands (Malvinas) Micronesia, Federated States of Faroe Islands France Gabon United Kingdom Grenada Georgia French Guiana Guernsey Ghana Gibraltar reenland Gambia Guinea Guadeloupe Equatorial Guinea Greece South Georgia and the South Sandwich Islands Guatemala Guam Guinea-Bissau Guyana Hong Kong Heard Island and McDonald Islands Honduras Croatia Haiti Hungary Indonesia Ireland Israel Isle of Man India British Indian Ocean Territory Iraq Iran Iceland Italy Jersey Jamaica Jordan Japan Kenya Kyrgyzstan Cambodia Kiribati Comoros Saint Kitts and Nevis South Korea North Korea Kuwait Cayman Islands Kazakhstan Lao Lebanon Saint Lucia Liechtenstein Sri Lanka Liberia Lesotho Lithuania Luxembourg Latvia Libya Morocco Monaco Moldova Montenegro Saint Martin (French part) Madagascar Marshall Islands Macedonia Mali Myanmar Mongolia Macao Northern Mariana Islands Martinique Mauritania Montserrat Malta Mauritius Maldives Malawi Mexico Malaysia Mozambique Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Netherlands Norway Nepal Nauru Niue New Zealand Oman Panama Peru French Polynesia Papua New Guinea Philippines Pakistan Poland Saint Pierre and Miquelon Pitcairn Puerto Rico Palestine, State of Portugal Palau Paraguay Qatar Réunion Romania Serbia Russian Federation Rwanda Saudi Arabia Solomon Islands Seychelles Sudan Sweden Singapore Saint Helena, Ascension and Tristan da Cunha Slovenia Svalbard and Jan Mayen Slovakia Sierra Leone San Marino Senegal Somalia Suriname South Sudan Sao Tome and Principe El Salvador Sint Maarten (Dutch part) Syrian Arab Republic Swaziland Turks and Caicos Islands Chad French Southern Territories Togo Thailand Tajikistan Tokelau Timor-Leste Turkmenistan Tunisia Tonga Turkey Trinidad and Tobago Tuvalu Taiwan Tanzania Ukraine Uganda United States Minor Outlying Islands United States Uruguay Uzbekistan Holy See (Vatican City State) Saint Vincent and the Grenadines Venezuela Virgin Islands, British Virgin Islands, U.S. Viet Nam Vanuatu Wallis and Futuna Samoa Yemen Mayotte South Africa Zambia Zimbabwe

Address

Telephone No.

E-Mail

3. Team members
Name and job title

4. Declaration
I/we hereby declare that I am / we are the originator(s) of the proposal,
have authority to use and alter the proposal for purpose of the further design development of the pompetition proposal and
to grant the awarding authority such rights as may be neccessary.
By signing this declaration I/we hereby also confirm the accuracy of the above information.

Declare