Aritrator Panel Status Application Form

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PARTICULARS OF APPLICANT


EDUCATION

(i) Level of academic qualification **

Year Awarded Degree/Certificate Institution

(ii) Arbitration training **

Year Nature of training Institution

(iii) Other training in dispute resolution **

Year Nature of training Institution

*   You will be requested to provide proof of qualification and training during approval.
** (If you have been involved in such training as a facilitator, trainer or instructor, you will be requested to describe your role.)

ARBITRATION EXPERIENCE

(a) Indicate the number of Arbitrations, if any, that you have acted and the role in the areas specified in the table below;

Commercial Construction Investor/State Other(Special)
Sole Arbitrator
Member arbitrator panel
Counsel/Agent

(b) Provide a brief outline/profile of disputes you have handled as an arbitrator;

Type of dispute (e.g Breach of Contract) Issues Value of dispute Nature of evidence * Duration of dispute

* e.g. documentary, oral, witnesses.

Yes No
Yes No
Yes No

OTHER INFORMATION


DECLARATION

I understand the Nairobi Centre for International Arbitration does not provide employment for any Arbitrator. I also understand the decision to nominate or appoint an Arbitrator or Arbitrators to any Arbitration referred to Nairobi Centre for International Arbitration is within the exclusive discretion of the Nairobi Centre for International Arbitration.

I hereby declare that the information provided herein is complete and accurate. I understand that a false statement may disqualify my application from consideration and I hereby give my consent to a personal investigation in connection with this application for NCIA Arbitrator Panel Status.

I agree, if accredited to NCIA Arbitrator Panel Status, to be bound by the terms and conditions applicable to NCIA Arbitrator Panel Status and to comply with the Arbitrator Panel Status Standard, the NCIA Code of Conduct for Arbitrators, Nairobi Centre for International Arbitration (Arbitration) Rules, 2015 or there amendments or alterations from time to time and any other professional or legal requirement to which I am subject.

Check this box if you agree with all the above