Panel Member / General Mediator / Family Mediator / Arbitrator Application Form

Part A. Personal Details

Full Name (English) *

*English name shall be restricted to 20 alphabets including punctuation and spacing

Chinese Name

Title

Date Of Birth

Sex

HKID No.

Mobile Phone No. *

Residential Phone No.

Fax No.

Email *

Home Address

Part B. Occupation

Company Name *

Input "N/A" if you cannot provide the company name

Office Phone No.

Position

Address

Responsibility

Part C. Employment History

Employment History 01

Name of Company
Position
Responsibility
Period

Employment History 02

Name of Company
Position
Responsibility
Period

Employment History 03

Name of Company
Position
Responsibility
Period

Employment History 04

Name of Company
Position
Responsibility
Period

Employment History 05

Name of Company
Position
Responsibility
Period

Part D. Professional Qualification

Professional Qualification 01

Professional Title
Membership Grade
Issuing Authority
Date Obtained

Professional Qualification 02

Professional Title
Membership Grade
Issuing Authority
Date Obtained

Professional Qualification 03

Professional Title
Membership Grade
Issuing Authority
Date Obtained

Professional Qualification 04

Professional Title
Membership Grade
Issuing Authority
Date Obtained

Professional Qualification 05

Professional Title
Membership Grade
Issuing Authority
Date Obtained

Part E. Academic Qualification

Academic Qualification 01

Master / Degree / Diploma / Certificate
University / Institution / School
Major / Field of Study
Date Obtained

Academic Qualification 02

Master / Degree / Diploma / Certificate
University / Institution / School
Major / Field of Study
Date Obtained

Academic Qualification 03

Master / Degree / Diploma / Certificate
University / Institution / School
Major / Field of Study
Date Obtained

Academic Qualification 04

Master / Degree / Diploma / Certificate
University / Institution / School
Major / Field of Study
Date Obtained

Academic Qualification 05

Master / Degree / Diploma / Certificate
University / Institution / School
Major / Field of Study
Date Obtained

Part F. Professional Experience relating Mediation / Arbitration

Professional Training received

Professional Experience relating Mediation / Arbitration 01

Awarding Institution
Details of Training (Mediation / Arbitration)
Date Obtained

Professional Experience relating Mediation / Arbitration 02

Awarding Institution
Details of Training (Mediation / Arbitration)
Date Obtained

Professional Experience relating Mediation / Arbitration 03

Awarding Institution
Details of Training (Mediation / Arbitration)
Date Obtained

Professional Experience relating Mediation / Arbitration 04

Awarding Institution
Details of Training (Mediation / Arbitration)
Date Obtained

Professional Experience relating Mediation / Arbitration 05

Awarding Institution
Details of Training (Mediation / Arbitration)
Date Obtained

Case(s) handled as a General Mediator / Family Mediator / an Arbitrator

Case(s) handled as a General Mediator / Family Mediator / an Arbitrator 01

Nature of Case (eg. Defamation, family issues, commercial disputes etc)
Role (eg. General Mediator / Family Mediator / Arbitrator)
Period (MM/YYYY-MM/YYYY)

Case(s) handled as a General Mediator / Family Mediator / an Arbitrator 02

Nature of Case (eg. Defamation, family issues, commercial disputes etc)
Role (eg. General Mediator / Family Mediator / Arbitrator)
Period (MM/YYYY-MM/YYYY)

Case(s) handled as a General Mediator / Family Mediator / an Arbitrator 03

Nature of Case (eg. Defamation, family issues, commercial disputes etc)
Role (eg. General Mediator / Family Mediator / Arbitrator)
Period (MM/YYYY-MM/YYYY)

Case(s) handled as a General Mediator / Family Mediator / an Arbitrator 04

Nature of Case (eg. Defamation, family issues, commercial disputes etc)
Role (eg. General Mediator / Family Mediator / Arbitrator)
Period (MM/YYYY-MM/YYYY)

Case(s) handled as a General Mediator / Family Mediator / an Arbitrator 05

Nature of Case (eg. Defamation, family issues, commercial disputes etc)
Role (eg. General Mediator / Family Mediator / Arbitrator)
Period (MM/YYYY-MM/YYYY)

Applicants may also submit your latest CV along with this application form.

Upload a file (Allow Multiple Files)

Support PDF / PNG / JPG / Docx / Doc / XLS / CSV format only. (Max file size <10mb)

Part G. Payment

Membership Type for Application

Member (Application Fee: HK$500)

General Mediator (Application Fee: HK$800)

Family Mediator (Application Fee: HK$800)

Arbitrator (Application Fee: HK$800)

Payment Amount for Membership Application (Auto Calculated by System)

Auto Calculated by System (HK$)

Payment Methods for Memberships Application

Hang Seng Bank or FPS

Cheque (By Post)

For Hang Send Bank or FPS:

Bank Name: Hang Seng Bank

Bank Account No. : 787-288018-001

Account Name: Hong Kong Mediation and Arbitration Centre Limited

For Cheque (Please note that you are still required to submit this form first):

Please send a crossed cheque payable to “Hong Kong Mediation and Arbitration Centre Limited,” together with your name and member ID, to:

Hong Kong Mediation and Arbitration Centre (Admin. Office), Unit 6, 9/F, LT Tower, No. 31 Chong Yip Street, Kwun Tong, Hong Kong.

(Please write your full name in English, and your contact telephone number on the back of the cheque for verification.)

Upload bank in slip (For Hang Seng Bank or FPS)

Support PDF / PNG / JPG format only. (Max file size <10mb)

Payment Date (For Hang Seng Bank or FPS)

Attach your updated photo in high resolution

Support PNG / JPG format only. (Max file size <10mb)

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Declaration

I hereby declare that I have read and understood the Policy on Personal Data (Privacy) Ordinance issued by the Hong Kong Mediation and Arbitration Centre. At my best understanding, all the information provided above is true and accurate and I agree that such information shall be received, stored, transferred, used, handled, kept and/or disclosed by the Hong Kong Mediation and Arbitration Centre where it reasonably considers it is necessary to do so.

Hong Kong Mediation and Arbitration Centre
Policy on Personal Data (Privacy) Ordinance (PDPO)

Personal Data

The Hong Kong Mediation and Arbitration Centre (“HKMAAC”) supports and will make effort to comply with the PDPO. Personal data of Honorary Members, Fellows, Professional Members, Members, Associate Members, Panel Mediators, Arbitrators, Students and other guests joining CPD programs or participating in any events of the HKMAAC (collectively referred as “Designated Persons”) will be used mainly for the following purposes:-

for membership and educational administration of the HKMAAC;
for distribution of HKMAAC’s publications, leaflets, newsletters, notices and circulars;
for membership profile analysis;
subject to the requirements of PDPO, for direct marketing of conferences, services and other activities organized by HKMAAC or other organizations (if Designated Persons do not wish to receive any promotional materials other than those directly from HKMAAC, please write to HKMAAC stating their membership/registration number, full name and address);
for purposes as specified at the time of data collection.

Transfer of Data

Personal data held by HKMAAC will be kept confidential but HKMAAC may provide necessary data to:

Any internal committee, staff or related person concerned for verification of subscription and CPD status of Designated Persons according to requirements under HKMAAC;
other professional organizations, societies, groups or individuals regarding any training, membership and/or disciplinary issues;
the Government or other authorities when required by law to do so.

Access and Correction of Personal Data

The right of access/correction of personal data under PDDO will be observed. Requests for access to or correction of data should be in writing and made to the Office of HKMAAC. A reasonable fee may be charged towards administrative expenses in complying with access requests.

Declaration

I hereby declare that all the information provided by me is true, accurate and complete. I understand that any incorrect or incomplete information may constitute professional misconduct. I have also read, understood and accept all the notes and information as provided under “Terms and Conditions for Application” in this form.