(Arbitrator/ Expert) Registration Form

App. Date / App No.
Personal Data
Full Name: (First/Middle/Last) /

Title (Dr., Mr., Ms., etc.):
Nationality: Gender : □ Male □Female
Date of Birth (day / month / year):
Place of Residence: State: City :
Contact Details
Phone (Res/Office): / Fax(Res/Office):
Mobile: / P.O Box:
Email:
  • Please choose preferred method for communication:
/ □Phone □Mobile □ Fax □Email
□Postal Address □Others......
Qualifications
Degree / Date Obtained / Institute
Languages
Language / Written / Spoken / Read
Excellent / Good / Fair / Excellent / Good / Fair / Excellent / Good / Fair
□ / □ / □ / □ / □ / □ / □ / □ / □
□ / □ / □ / □ / □ / □ / □ / □ / □
□ / □ / □ / □ / □ / □ / □ / □ / □
Employment History /
  • Please outline your employment history for the past 5years and attach your CV.

Date / Organization / Job Title / Responsibilities in Brief
from / To
Fields of Experience /
  • Please select areas of Specialization

□Commercial Law / □Banking / □Oil & Gas Law / □Construction Law
□Company Law / □Bankruptcy / □Environmental Law / □Contract Law
□Competition Law / □Engineering / □Sharia Law / □Air Law
□Conflicts of Law / □Taxation / □Intellectual Property / □Maritime Law
□Insurance / □Royalties / □Transfer of Technology / □Foreign Investment
  • Others (Please Specify): ......

Publications /
  • Please provide us with information about your intellectual contributionin the field of expertise.

Contribution / Type
(research/article /book / etc ..) / Description
Arbitration Experience /
  • Number and nature of cases in which you participated as an arbitrator or an advocate in the last 5 years.

Please provide the reference number for each case where the arbitration has been under an arbitral institution, otherwise provide an abbreviated reference of the parties without violating confidentiality where the arbitration is Ad Hoc
ArbitrationCenter / Case Ref. No / Dispute Nature / Sum in Dispute(Approximate) / Date of Rendered Award
Arbitration Training /
  • Please list the training programs you attended in dispute resolution and arbitration (attach evidence of completion for each programs)

Date / Program Title / Institute Name / Other Details
From / To
Professional Membership /
  • List all dispute resolution institutes/ organizations of which you are a member of.

Institute/ Organization / Date of Admission / Status
Additional Information /
  • Provide any other information which supports your application (attach extra sheets as necessary)

......
......
......
......
......
Declaration :
I, the undersigned, hereby confirm that the above information is true, complete and accurate to the best of my knowledge.
Signature : ...... Date:...... /...... /......

For Official Use :

Application receipt Date: ……/……/……. Date referred to committee: ……/……/…...….
Committee Decision: ......
......
Date of decision:……/……/…….. Signature:………......
1 / AjmanCenter for Commercial Conciliation & Arbitration -4th Floor,AjmanChamberBuilding,P.O Box:662Ajman, UAE
Tel: 00971-6-7016218 , 00971-6-7016212 , Fax: 00971-6-7016313, Email: