IIAM EMPANELMENT FORM FOR NEUTRALS
Instructions / (Photo)· Kindly complete all the information sought
· Kindly sign the first page of the Form and submit a duly completed scanned copy of the first page of the Form. Submit the duly completed entire Form in word format, together with softcopy of your passport size photo in a jpeg format
· Submission to be made in soft version addressed to the IIAM Executive Director –
AGREEMENT, CONFIRMATION AND DECLARATION
I agree to accept the appointment to serve as:
Arbitrator
Emergency Arbitrator
Mediator
on the IIAM Panel of Neutrals and consent to the Indian Institute of Arbitration & Mediation (IIAM) using and disclosing to third parties or exhibiting in the IIAM website, any information provided by me in this Empanelment Form as may be reasonably necessary to carry out the activities and perform the services of IIAM.
I am willing to arbitrate / mediate as per the IIAM Arbitration or Mediation Rules.
I understand that the empanelment will be at the sole discretion of IIAM.
I declare that the information given by me in this Empanelment Form is true to the best of my knowledge.
______
Signature Date
Name Place
PERSONAL PARTICULARS
In order to facilitate their appointment as neutrals, Panellists shall notify IIAM as soon as possible in the event there is any change to their personal particulars.
First Name
Surname
Age / Sex
Designation / Position
Organisation
Telephone / Mobile number(s)
Address
Country of nationality or ordinary residence / State
City of residence / practice
Language(s) known
EMPANELMENT
Please select the neutral categories in which you would like to empanel.
Arbitrator
Emergency Arbitrator / Mediator
ARBITRATOR / EMERGENCY ARBITRATOR Not Applicable
Accreditation - Certification / Certified
Not applicable
If Certified, details of certification
Applicable Fee Schedule / IIAM Arbitration Fee Schedule
Separate Fee Schedule
If Separate Fee Schedule, details of Fee structure
Any restriction on quantum of claim (Minimum amount of claim in a dispute under which to be appointed) / Yes
No
If Yes, the minimum amount
Any restriction on type of disputes / Yes
No
If Yes, type of disputes
(Specify types you want to include)
Arbitration experience
(Specify both domestic and international)
Willing for outstation arbitration / Domestic: Yes No
International: Yes No
· IIAM Arbitration Rules can be downloaded from www.arbitrationindia.com/pdf/rules_arbitration.pdf
· IIAM Arbitration Fee Schedule can be downloaded from www.arbitrationindia.com/pdf/arbitration_fee.pdf
MEDIATOR Not Applicable
Accreditation - Certification / IMI Certified
IIAM Grade B IIAM Grade C
Other certification
In case of other certification, details
Mediator training details
Mediation styles / Facilitative Evaluative
Transformative
Applicable Code of Conduct / IIAM Mediators Code of Professional Conduct
Other Code of Conduct
In case of other Code, details
Applicable Fee Schedule / IIAM Mediation Fee Schedule
Separate Fee Schedule
If Separate Fee Schedule, details of Fee structure
Any restriction on quantum of claim (Minimum amount of claim in a dispute under which to be appointed) / Yes
No
If Yes, the minimum amount
Any restriction on type of disputes / Yes
No
If Yes, type of disputes
(Specify types you want to include)
Mediation experience
(Specify both domestic and international)
Willing for outstation mediation / Domestic: Yes No
International: Yes No
· IIAM Mediation Rules and IIAM Mediators Code of Professional Conduct can be downloaded from www.arbitrationindia.com/pdf/rules_mediation.pdf
· IIAM Mediation Fee Schedule can be downloaded from www.arbitrationindia.com/pdf/mediation_fee.pdf
SPECIAL INSTRUCTIONS / ADDITIONAL DETAILS Not Applicable
PROFILE
Please provide a brief bio-data (not exceeding 350 words)
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