AALCO-HKRAC PANEL OF ADJUDICATORS FOR CONSTRUCTION INDUSTRY SECURITY OF PAYMENT ORDINANCE EMPANELMENT APPLICATION FORM 1. PERSONAL DETAILS*TITLE *MrMsDrProfLAST NAME *FIRST NAME(S) *DATE OF BIRTH *NATIONALITY *Select an optionAmericanAustralianBelgiumBenineseBritishBrunei DarussalamCameroonianCanadianChineseDutchEgyptianFilipinosFrenchGermanIndianIndonesiansItalianJapaneseJordanianKenyanMalaysianNew ZealanderNigerianNorwegianPakistaniPortugueseRussianSingaporeanSouth AfricanSouth KoreanSpanishSwedishSwissThaiVietnamesePLACE OF BIRTH *Select an optionAmericaAustraliaBelgiumBeninBrunei DarussalamCameroonCanadaChinaEgyptFranceGermanyHong KongIndiaIndonesiaItalyJapanJordanKenyaMalaysiaNetherlandsNew ZealandNigeriaNorwayPakistanPhilippinesPortugalRussiaSingaporeSouth AfricaSouth KoreaSpainSwedenSwitzerlandThailandUnited KingdomVietnamCOMPANY/BUSINESS NAME *COMPANY/BUSINESS ADDRESS *COMPANY WEBSITE *RESIDENTIAL ADDRESS *EMAIL ADDRESS *MORE EMAIL ADDRESSEMAIL ADDRESS 2MORE EMAIL ADDRESSEMAIL ADDRESS 3 *MORE EMAIL ADDRESSEMAIL ADDRESS 4 *CONTACT NUMBER *CURRENT PROFESSIONAL ACTIVITIES AND POSITION(S) * 2. PROFESSIONAL QUALIFICATIONS * The applicant must hold any one of the following professional qualifications listed in items (a), (b), or (c):a) Architect, Engineer, Surveyor with HKIA Membership/ HKIE/HKIS Corporate Membership;(Please attach copies of certificates/membership proof. Max 8Mb each.)The Hong Kong Institute of Architects (HKIA)The Hong Kong Institution of Engineers (HKIE)The Hong Kong Institute of Surveyors (HKIS)The Hong Kong Institute of Architects (HKIA)TYPE OF MEMBERSHIP *YEAR OBTAINED *Upload Proof *Choose FileNo file chosenDelete uploaded fileThe Hong Kong Institution of Engineers (HKIE)TYPE OF MEMBERSHIP *YEAR OBTAINED *Upload Proof *Choose FileNo file chosenDelete uploaded fileThe Hong Kong Institute of Surveyors (HKIS)TYPE OF MEMBERSHIP *YEAR OBTAINED *Upload Proof *Choose FileNo file chosenDelete uploaded fileb) Registered Architect/ Registered Professional Engineer/ Registered Professional SurveyorYes(Please attach copies of certificates/membership proof. Max 8Mb each.)REGIDTRATIONAL BODY *TYPE OF PROFESSIONAL *YEAR OBTAINED *Upload Proof *Choose FileNo file chosenDelete uploaded filec) Legal professional holding a valid practising certificate issued by Law Society of Hong Kong/ Hong Kong Bar Association.Yes(Please attach copies of certificates/membership proof. Max 8Mb each.)PROFESSIONAL BODY *TYPE OF PROFESSIONAL *YEAR OBTAINED *Upload Proof *Choose FileNo file chosenDelete uploaded fileThe applicant must hold any one of the above professional qualifications listed in items (a), (b), or (c): 3. POST-QUALIFICATION EXPERIENCE*Application for (Select one only) : *AALCO-HKRAC Panel of AdjudicatorsAALCO-HKRAC Panel of Senior AdjudicatorsA. Adjudicator CategoryContract Administration ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileClaims Assessment ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileVariation Valuation ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileDispute Resolution ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileConstruction Litigation ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileTotal Experience (Years)(Minimum 7 years total)Experience in Hong Kong *(Minimum 5 years in Hong Kong)B. Senior Adjudicator CategoryContract Administration ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileClaims Assessment ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileVariation Valuation ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileDispute Resolution ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileConstruction Litigation ExperienceDetails of Roles/ProjectsAttach Annex if needed.Choose FileNo file chosenDelete uploaded fileTotal Experience (Years)(Minimum 12 years total)Experience in Hong Kong *(Minimum 10 years in Hong Kong) 4. ADJUDICATION TRAINING*Provider/Institution *AALCO-HKRACHKIAHKIEHKISOTHERSAALCO-HKRACCourse/Certification Name *Date of Completion *(Must be within 4 years preceding application; Attach certificate if available)Upload CertificateChoose FileNo file chosenDelete uploaded fileHKIACourse/Certification Name *Date of Completion *(Must be within 4 years preceding application; Attach certificate if available)Upload CertificateChoose FileNo file chosenDelete uploaded fileHKIECourse/Certification Name *Date of Completion *(Must be within 4 years preceding application; Attach certificate if available)Upload CertificateChoose FileNo file chosenDelete uploaded fileHKISCourse/Certification Name *Date of Completion *(Must be within 4 years preceding application; Attach certificate if available)Upload CertificateChoose FileNo file chosenDelete uploaded fileOthersCourse/Certification Name *Date of Completion *(Must be within 4 years preceding application; Attach certificate if available)Upload CertificateChoose FileNo file chosenDelete uploaded fileProvider/Institution 5. ACADEMIC QUALIFICATIONS*Please list any relevant academic qualifications (e.g. undergraduate or postgraduate degree, diploma, etc).ORGANISATION AND QUALIFICATION *GRADE *YEAR OBTAINED * 6. INTEGRITY DECLARATION*(Tick all boxes to confirm compliance)I have never been convicted by any court for corruption, fraud, conspiracy to defraud, or dishonesty-related offences.I have no findings of misconduct by any disciplinary tribunal.I confirm no prior offence renders me unsuitable for the AALCO-HKRAC Panel. 7. LANGUAGESPlease specify all your language proficiencies (including English).LANGUAGE *Select an optionArabicBahasa MelayuBelgiumBruneianChinese (Cantonese)Chinese (Putonghua)DanishDutchEnglishFilipinoFrenchGermanHindiIndonesianItalianJapaneseKoreanPortugueseRussianSpanishThaiWRITINGSelect OneExcellentGoodFairSPEAKINGSelect OneExcellentGoodFairTECHNICAL TERMINOLOGYSelect OneExcellentGoodFair 8. GENERAL AVAILABILITY TO ACCEPT APPOINTMENTS 9. ESTABLISHED AND RECOGNISED REPUTATION IN YOUR FIELDPlease list any professional recognition(s) (e.g. awards, rankings in professional directories, etc.) you have achieved during the course of your career. 10. ADDITIONAL INFORMATION (optional)Please provide any additional information relevant to your application. 11. UPLOAD FILESDrag and Drop (or) Choose FilesNotes:- 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. Upon satisfactory assessment I authorise AALCO-HKRAC to use information that I have submitted for the purposes of promoting and administering adjudication 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. 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. 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 adjudicators and disputes resolvers. 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 I have read and agreed to the Personal Data (Privacy) Ordinance Notice. 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. 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 adjudicators and disputes resolvers. 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 adjudicators, should I be successful. I confirm that I am familiar with and will adhere to the AALCO-HKRAC Terms of Empanelment and the AALCO-HKRAC Security of Payment Adjudication Rules. 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. 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 [email protected]. 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.SIGNATURE *Start signing your signature hereYour browser does not support e-Signature field.Date *FULL NAME *Submit