Formal Application Form

In the matter of:

Claimant/First Party: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Telephone number: *

Email: *

Case Reference: *

Additional parties (please provide details): *

Please provide full details of any representative(s) supporting the claimant(s) - (Organisation, position, individual name(s), email, contact details) : *

Respondent/Secound Party *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Telephone number: *

Email: *

Case Reference: *

Additional parties (please provide details): *

Please provide full details of any representative(s) supporting the Respondent(s) - (Organisation, position, individual name(s), email, contact details) : *

Details of the dispute.

Preference for the neutral(s) background and skills:

Party one:

Industry/Sector: *

Professional or Academic qualifications: *

Specialist experience: (if any) *

Knowledge/Profession: *

Language of the neutral(s): *

Additional information (i.e: name(s) of suitable neutral(s), with reasons - No guarantee can be placed that the individual(s) will be appointed) : *

Party two:

Industry/Sector: *

Professional or Academic qualifications: *

Specialist experience: (if any) *

Knowledge/Profession: *

Language of the neutral(s): *

Additional information (i.e: name(s) of suitable neutral(s), with reasons - No guarantee can be placed that the individual(s) will be appointed) : *

The purpose of your request:

Please highlight the applicable box *

If you have selected 'Rules' or 'Act'' from the above box, please provide further information:

Attach supporting documents
Please attach or email separately any correspondence which you feel may support the administration of the case. Please note, all documents relating to the case should only be sent to the neutral(s) once they have been officially appointed by Prime Dispute.

Our Terms

Fees

A fee will be charged by Prime Dispute for the 'Appointment/Nomination' and if requested the 'Administration of the case'. Please read 'Administration Process of Cases Note' and 'Schedule of Fees for all Cases' .

It is agreed as a condition of such an appointment/nomination that the applicant shall:

Pay the reasonable fees and expenses of the neutral, whether or not any decision is made.
Inform the neutral in the event of the settlement of the dispute before any decision is made or any further fees and expenses are incurred.

Privacy
Prime Dispute takes the privacy and security of the personal information you provide seriously. Your details are held in a secure database with access provided to senior personal only. We apply data processing policies in compliance with the General Data Protection Regulation (GDPR) and the Privacy and Electronic Communications Regulations (EC Directive 2003). Prime Dispute will not use the information you provide in this request to contact you with offers of products and services. Prime Dispute will not share your information with third parties for the purpose of sending you details of offers of products or services. Please read our Terms and Conditions on our website.

Conflicts
Prime Dispute will take reasonable steps to ensure that the nominated neutrals is free from conflict of interests. It is therefore essential that you provide detail(s) of the parties involved, which include any companies or related entities that a neutral would need to consider in their conflict checks. Neutral(s) are required to disclose involvement or potential conflicts of interest to Prime Dispute prior to nomination. Prime Dispute will never knowingly nominate a neutrals who has a conflict of interest. If in your view there are any neutral(s)who would have a conflict of interest regarding this matter, you should list them in the box below. Please also provide for such person; brief but clear reasons for this statement.Your attention is drawn to the decision in "Eurocom Ltd -v- Siemens Plc [2014] EWHC 3710 (TCC) " to the effect of misrepresentations in this statement could invalidate the nomination process in its entirety, rendering any decision/award made unenforceable. Your application is accepted on this basis - .

APPLICATION FORM.FORMAL APPOINTMENT/NOMINATION REQUEST

APPLICATION FORM.
FORMAL APPOINTMENT/NOMINATION REQUEST