Application Form for SHIAC’s Panel of Arbitrators/Mediators

(for foreign, China HK SAR, China Macau SAR and China Taiwan Region applicant to fill in)

Personal Information
Full Name
(Surname Capitalized) / photographplease
Gender
Date of Birth / (YY/MM/DD)
Nationality
Identity Document Type and Number / □Passport
□Mainland Travel Permit for Hong Kong and Macao Residents
□Mainland Travel Permit for Taiwan Residents
□Others:______
Document Number
Please tick according to different types, fill in the document number and attach the copy.
City of Residence
Highest Education
Email
Mobile Number
Employment Information
Employed in:
Business Address:
Current Position
Professional Specialties
Business Phone
Office Fax
Part Times in Social Organization:
Work Experience
Your CV is very much appreciated.
Arbitration Related Information
Arbitrator or mediator of other institutions or not / □Yes / □No
If Yes, please fill in the following blanks with “*”.
*Names of Institutions
*Year of Appointment
Application Method / □Unit Recommended
Name of Unit Recommended:______
□Arbitrator Recommended
Name of Arbitrator Recommended:______
□ Others: ______
Relevant Experience of Arbitration / □Former Judge
Term of Office: ______
Name of Trial Agency(Court): ______
□Lawyer
Practice Period: ______
Time of obtaining Professional Qualification: ______
Professional Qualification Number: ______
□Arbitration Practitioners
Practice Period: ______
Time of obtaining Legal Occupation Qualification: ______
Certificate Number: ______
□Person doing Legal Scientific Research and Teaching work
Title Category: ______
Certificate Number: ______
□Experts with knowledge of the law or Economic and Trade Experts
Title Category: ______
Certificate Number: ______
Time of obtaining Legal Occupation Qualification: ______
Certificate Number: ______
□Others: ______
Please attach the relevant the copy of certificate if there was.
*Experience in Arbitration
Include but not limited to any experience as an arbitrator in any arbitration, or any academic research achievement in arbitration
Other ADR Experience
Professional Specialties in Arbitration/Mediation
Please use Key words when describing and rank them accordingly. The first 4 will be printed in Panel of Arbitrators.
□Manufacture and Trade of Aircraft and Parts
□Aviation Operation
□Aviation Service
□Aviation Finance, Insurance
□ Others: ______
SHIAC has set up Shanghai International Aviation Court of Arbitration. If your specialty is related to aviation, please check it in the above-mentioned subdivided specialty or describe it separately.
Working Languages
SelfDescription
Please briefly describe your business, specialty and background.
Address for Document Serving Zip Code
This address will be seen as the address for serving arbitration documents. Your prompt updating of address changing to the Secretariat is much appreciated.
  1. Ideclare that the information provided in support of this application is accurate and complete；
  1. I amclearly aware of the Article 13 of the Arbitration Law of the People’s Republic of China;
  1. I have never committed any crimenor determined improper behaviorwhich would probably lead to disqualified as the arbitrator/mediator；
4. I promise to fully perform the duties of arbitrator/mediator,abide by professional ethics, abide by the code of arbitrator /mediator and relevant management regulations；
5. Any information filled in this form might be disclosed by SHIAC to particular third party, when necessary, in case I would be appointed as the arbitrator/mediator in arbitration.
Based on the above statements:
□I am willing to act as an arbitrator of SHIAC.
□I am willing to act as a mediator of SHIAC
.
Signature: Date:
Declaration

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