MAC

Full Name: Mr./Ms./Mrs.

(in Block letters)

Address:

Occupation:

Phone/s: (Office): (Resi.): Fax:

Email:

Date of Birth: Age: Nationality:

Father's/Husband's Name:

(Please attach supporting documents for the purposes of office records)

Educational/Professional Qualifications (Graduation onwards):

Course Name and Address of College/Institution	University	Year of Passing

(Please attach supporting documents for the purposes of office records)

Experience:

Employers' Name	Address	Position	Period
			From	To

Members of the following:

Organisations	Position	Period
		From	To

Categories of Panel of Arbitrators:

Please tick the one of the following Categories you wish to join:

Judges

Advocates

Engineers

Chartered Accountants/Financial Experts

Executives

Shipping

Businessmen

Foreign Nationals

Other Area

Fields of Specialization:

(Please put numbers (i.e. 1,2,3…) based on your priority of experience or knowledge)

Agency & Distribution and Franchising

Engineering/Technical

Intellectual Property

Joint Ventures

Real Estate

Power Energy

State Contracts

Aviation

Finance Banking

International Investments

Commercial Contracts

Maritime Shipping

Telecommunications

Construction

Insurance

Information Technology

Oil, Petroleum and Gas

Securities

Steel, Mining & Quarying

Corporation & related activities

Agriculture & Food Processing

Hotel & Tourism Industry

Automobile

Entertainment

Corporate Law

Environment

Taxation

Transport

Textile/Jute Industry

Computer Software

Other Areas

Specialisation & Knowledge of the following products/business:

Tobacco Products

Wearing Apparel

Tanning & dressing of leather

Wood & Products of Wood & cork except furniture

Paper & Paper Products

Coke, refined petroleum products and nuclear fuel

Printing and reproduction of recorded media

Chemicals and Chemical Products

Other Non-Metallic Mineral Products

Rubber and Plastic Products

Fabricated Metal Products, except Machinery & Equipment

Basic Metals

Machinery and Equipment

Office, Accounting and Computing Machinery

Electrical Machinery Equipment and Apparatus

Radio, Television and Communication Equipment and Apparatus

Medical, Precision and Optical Instruments, Watches and Clocks

Motor Vehicles, Trailers and Semi-trailers

Other Transport Equipment

Furniture Manufacturing

Gem & Jewellery

Recycling

Other Areas

Specialisation & Knowledge of the following products/business:

(List out 5 products/business)

Arbitration/Mediation Training:

Course Name	Organisation	Period

Arbitration/Mediation Experience:

Number of cases:	As Arbitrator	As Mediator	As Conciliator
Sole Arbitrator/Mediator/Conciliator
Co Arbitrator/Mediator/Conciliator

Field of Arbitration/Mediation/Conciliation Experience

In case you have no training or experience as yet in Arbitration or Mediation, please state reasons for your interest in wanting to join as Arbitrator/Mediator in MAC:

Name of ADR Courses/Seminars/Conferences participated:

Addressed:

Participated:

Title of Paper presented (Enclose a set of Paper) (if any):

Undertakings: -

a) I agree to abide by the Rules of Metro Mediation and Arbitration Centre.

b) I shall take up and complete the arbitration assigned to me with utmost diligence and expedition.

c) All arbitrators being of equal status, I shall not object to my appointment as arbitrator in a particular case on the basis of my previous status or that of any appointed arbitrator.

d) I have not been convicted or charged of any offence or any criminal investigation or vigilance enquiry pending against me.

e) I declare that I have not been removed as arbitrator in circumstances where moral probity or incompetence were an issue.

f) I declare that above particulars furnished are true & correct.

Date:

Signature of the Applicant

Place: