NAME:
CONTACT DETAILS:
PRIOR EXPERIENCE (INCLUDING EXPERIENCE WITH ARBITRATIONS):
NUMBER OF ONGOING ARBITRATIONS:
CIRCUMSTANCES DISCLOSING ANY PAST OR PRESENT RELATIONSHIP WITH
ORINTEREST IN ANY OF THE PARTIES OR IN RELATION TO THE SUBJECT-MATTER
INDISPUTE, WHETHER FINANCIAL, BUSINESS, PROFESSIONAL OR OTHER KIND, WHICH IS
LIKELY TO GIVE RISE TO JUSTIFIABLE DOUBTS AS TO YOURINDEPENDENCE OR
IMPARTIALITY (LIST OUT):
CIRCUMSTANCES WHICH ARE LIKELY TO AFFECT YOUR ABILITY TO DEVOTE
SUFFICIENT TIME TO THE ARBITRATION AND IN PARTICULAR YOUR ABILITY TO FINISH
THE ENTIRE ARBITRATION WITHIN TWELVE MONTHS (LIST OUT):
