Panel of Mediator Application Form

PERSONAL DETAILS

ADMISSION TO LEGAL PROFESSION

Please list any jurisdiction in which you are a legal professional or authorized practitioner.

PROFESSIONAL MEMBERSHIPS

Please list any professional memberships you hold that are relevant to this application.

ACADEMIC QUALIFICATIONS

Please list any relevant academic qualifications (e.g. undergraduate or postgraduate degree, diploma, etc).

MEDIATION EXPERIENCE

LANGUAGES

Please specify all your language proficiencies (including English). Scale: E = Excellent G = Good F = Fair

1. Please fill in all sections in block letters. If there is insufficient space, provide details on a separate A4 sheet in the same format. In case any section of the form is not applicable, please put in N/A.
2. Upon satisfactory assessment I authorise AALCO-HKRAC to use information that I have submitted for the purposes of promoting and administering mediation and other alternative dispute resolution proceedings.

Personal Data (Privacy) Ordinance Notice

Persons who supply data in their application to the AALCO Hong Kong Regional Arbitration Centre (AALCO-HKRAC) are advised to note the following points pursuant to the Personal Data (Privacy) Ordinance of Hong Kong.

1. Personal data provided in this application form will be used for the purpose of assessment for AALCO Hong Kong Regional Arbitration Centre panel listing, and in this connection the data herein will be dealt with by the AALCO-HKRAC staff and/or by the relevant committee members.
2. After an application for assessment has been duly processed, the application papers of the candidates will be retained in a file established by the AALCO-HKRAC for each applicant. Such information will be retained by AALCO-HKRAC for as long as it deems necessary or useful, such as being made available in search functions for the public to look for mediators and disputes resolvers.
3. Under the provisions of the Personal Data (Privacy) Ordinance, an applicant has the right to request access to, and the correction of, his/her personal data as retained by the AALCO-HKRAC. Applicants wishing to access or make corrections to their data should submit written requests to the AALCO-HKRAC.

Declaration

1. I have read and agreed to the Personal Data (Privacy) Ordinance Notice.
2. I authorise the AALCO-HKRAC, its staff, employees and/or members of the AALCO-HKRAC to deal with, utilise and/or assess the data submitted by me, as may be required, in connection with my application for inclusion on the AALCO-HKRAC Panel.
3. I understand that my data will become a part of the AALCO-HKRAC files and may be used for all purposes deemed necessary or useful by the AALCO-HKRAC, such as being made available in search functions for the public to look for mediators and disputes resolvers.
4. I declare that the information given in support of this application is accurate and complete. I understand that any misrepresentation will disqualify my application and may lead to revocation of my inclusion of the AALCO Hong Kong Regional Arbitration Centre panel of mediators, should I be successful.
5. I confirm that I am familiar with and will adhere to the AALCO-HKRAC Terms of Empanelment and the AALCO-HKRAC Mediation Rules.
6. Any information on this form may be made available by AALCO-HKRAC to third parties for the purpose of AALCO Hong Kong Regional Arbitration Centre panel inclusion, selection and maintenance.
7. I have forwarded my up-to-date resumé along with this application form and I have submitted the same to the Director of the AALCO-HKRAC via the email address [email protected] on (insert date of submission by email) . I authorize AALCO-HKRAC to publish such resume on the AALCO-HKRAC website.

Please sign below to confirm your agreement to the disclosure of the information contained in the application and your confirmation of its accuracy.