/ UNRWA Dispute Tribunal
Insert applicant’s last name
v.
COMMISSIONER-General
of UNRWA
REQUEST for eXTENsion of TIME TO FILE AN APPLICATION

Date of Request:

Counsel for applicant:

If self-represented, please state so.

Counsel for respondent:

If unknown, leave blank.

Notice: This application should not exceed six pages (excluding supporting documents). Please submit this application and any supporting documents, preferably electronically, to the
Registrar
UNRWA Dispute Tribunal
UNRWA HQ Amman
P.O. Box 140157
Amman11814, Jordan
Email:
I.Applicant’s personal information
Please provide all dates in the following format—dd/mm/yyyy.
  1. Title (Mr., Mrs. or Ms.):
  2. Last name:
  3. First name:
  4. Middle name:
  5. Date of birth:
  6. Nationality:
  7. UNRWAIndex number:
  8. If you are a former UNRWA staff member, state your separation date:
  9. If you are currently a UNRWA staff member, provide your employment status:
  10. Type of appointment:
  11. Grade and step:
  12. Functional title:
  13. Department/Office/Section:
  14. Duty station:
  15. Employment status at the time of the contested decision (if different from above):
  16. Type of appointment:
  17. Grade and step:
  18. Functional title:
  19. Department/Office/Section:
  20. Duty station:
  21. Applicant’s contact information:
  22. Email address for correspondence:
  23. Optional email address:
  24. Facsimile:
  25. Work phone:
  26. Home phone:
  27. Cellular phone:
  28. Physical address for service of documents:
  29. If submitting application on behalf of an incapacitated or deceased staff member:
  30. Name of staff member:
  31. Relationship to staff member:

II.Legal Representative
If you nominate a legal representative, all case-related communications will be sent through him or her. Please attach your authorization for the legal representative.
  1. Are you assisted by a legal representative? Yes __ No __
  2. If yes, identify whether you are represented by:

__ the Legal Officer, Staff Assistance;

__ a volunteer (staff member or former staff member); or

__ a private lawyer.

  1. Please provide the legal representative’s contact information:
  1. Name:
  2. Place of work and functional title:
  3. Email address:
  4. Mailing address:
  5. Work phone:
  6. Cell phone:
  7. Fax:
  1. If you are represented by a private lawyer, provide details of jurisdiction in which he or she is admitted to practice and date of admission to practice:

III.Details of the contested decision
  1. Briefly describe what the decision was about:
  2. Name and title of official who made the decision:
  3. Name and title of author of the communication by which you were informed of the decision:
  4. Date on which the decision was made:
  5. Date on which the decision was notified to you or on which you first came to know about the decision:

IV.Request for Review
  1. Have you requestedamanagement review of the contested decision? Yes __ No __
  2. If yes, when (date)?
  3. Have you received a response? Yes __ No __
  4. If yes, date of the response and date on which you received it:

V.How much extra time do you need to file your application?
Please refer to art. 8.1(d)(i) of Regulation 11.3 ( Statute of the UNRWA Dispute Tribunal) and art.3.1 of Regulation 11.4 (Rules of Procedure of the UNRWA Dispute Tribunal) of the Area Staff Regulations (Cod./A/59/Rev.25/Amend.120, 1 June 2010) and International Staff Regulations (Cod.I/61/Rev.3/Amend.94, 1 June 2010). In general, staff members may file applications within 90 calendar days from the date of receipt of the outcome of the request for review or from the date of expiration of the deadline for thedecision review.
VI.What are your reasons for requesting this extension of time?
Please number all paragraphs.
VII.Documents in support of your request for extension of time
Please attach any material explaining why you need an extension of time. Include copies of the contested decision, the request for review and the decision, if any. If you include translations of any documents, please state so.
Annex number / Title (include nature of communication, author and addressee) / Date (dd/mm/yyyy)
VIII.Signature and certification

I hereby certify that to the best of my knowledge the information provided in this application form is true, accurate and complete and that all copies submitted to the UNRWA Dispute Tribunal are true copies of the original documents.

Applicant:

Name: / Date:
Signature:

Counsel (if applicable):

Name: / Date:
Signature:

Representative submitting on behalf of an incapacitated or deceased Staff Member

Name: / Telephone
Address / E-mail
Signature: / Date:

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June 2011