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APPLICATION FORM.
FORMAL APPOINTMENT/NOMINATION REQUEST
Please read
'
Administration Process of Cases Note'
and
'
Schedule of Fees for all Cases'
before you complete the below application.
Please select:
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Request for Arbitration (1 Arbitrator only)
Request for Arbitration (2+ Arbitrators - Arbitral Tribunal)
Request for Arbitration (Expedited Arbitration)
Request for Arb-Med
Request for Adjudication
Request for Commercial Negotiation
Request for Conciliation
Request for Dispute Board Member
Request for Early Neutral Evaluation
Request for Emergency Arbitration
Request for an Expert Witness
Request for an Independent Expert
Request for Med-Arb
Request for Mediation
Request for Online Dispute Resolution (ODR)
Request for a Specialist Panel
Other
If more than one neutral is required please provide a number and reasons.
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'Other' or 'Documents Only' , please confirm:
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In the matter of:
Claimant/First Party:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Telephone number:
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Email:
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Case Reference:
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Additional parties (please provide details):
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Please provide full details of any representative(s) supporting the claimant(s) - (Organisation, position, individual name(s), email, contact details) :
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Respondent/Secound Party
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Address
*
Line 1
Line 2
City
State
Zip Code
Country
Telephone number:
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Email:
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Case Reference:
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Additional parties (please provide details):
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Please provide full details of any representative(s) supporting the Respondent(s) - (Organisation, position, individual name(s), email, contact details) :
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Please provide dates regarding any holiday periods the party(s) may be unavailable:
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Please provide dates regarding any holiday periods the party(s) may be unavailable:
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Details of the dispute.
Claimant(s) - Please provide brief details (nature, amount of claim & circumstances) regarding the issues concerned (you are able to attach relevant documents below (i.e: Statement of Claim) or email them :
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Respondent(s) - Please provide brief details (nature, amount of claim & circumstances) regarding the issues concerned (you are able to attach relevant documents below (i.e Statement of Claim) or email them :
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Preference for seat of hearing(s) or meeting(s) with the neutral(s):
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Preference for seat of hearing(s) or meeting with the neutral(s):
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Preference for the neutral(s) background and skills:
Party one:
Industry/Sector:
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Professional or Academic qualifications:
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Specialist experience: (if any)
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Knowledge/Profession:
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Language of the neutral(s):
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Additional information (i.e: name(s) of suitable neutral(s), with reasons - No guarantee can be placed that the individual(s) will be appointed) :
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Party two:
Industry/Sector:
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Professional or Academic qualifications:
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Specialist experience: (if any)
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Knowledge/Profession:
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Language of the neutral(s):
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Additional information (i.e: name(s) of suitable neutral(s), with reasons - No guarantee can be placed that the individual(s) will be appointed) :
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The purpose of your request:
Please highlight the applicable box
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Single request
Unilateral application
Joint Application
Request by the Court
Prime Dispute Arbitration Rules
Prime Dispute Mediation Rules
Rules/Act
Ad-Hoc
Other
Single request:Either the claimant or respondent has the authority to request a formal appointment. Unilateral application: An Agreement/Contract between the parties, includes the provision that in the event of a dispute, either party may apply to Prime Dispute to appoint a neutral. Joint Application: The parties have jointly agreed to apply to Prime Dispute to appoint a neutral. Request by the Court: The Court has requested either party to make an application for an independent neutral to be appointment. Rules: Both parties have agreed to use our free administrative service, but another bodies/organisations rules.
If you have selected 'Rules' or 'Act'' from the above box, please provide further information:
Act/Rules
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If you have selected 'Other' or would like to provide further clarification, please do so within the attached box.
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Please select as appropriate:
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'Appointment/Nomination' Only
'Appointment/Nomination' and 'Administration'
Other
If you have selected 'Other' or would like to provide further clarification, please do so within the attached box.
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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.
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
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 - .
Claimant(s) - Conflict of Interests
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Respondent(s) - Conflict of Interests
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Claimant(s) Upload File - Conflict of Interests
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Max file size: 20MB
Respondent(s) Upload File 'Conflict of Interests'
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Max file size: 20MB
Please tick if you agree (Do not complete this form if you do not want Prime Dispute to collect, store, share and process your information):
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I/We agree to the above terms.
Both parties agree to the above terms.
On behalf of our client/s we agree to the above terms.
The respondent(s) are not aware we have submitted this case(s), but we agree to the terms.
Other
Title
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Name
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First
Last
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Indicates required field
Email
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Payments may be made by a cheque, payable to "Prime Dispute Limited" or by bank transfer to our bank account. For bank details please email contact@primedispute.com . Should you require an invoice, please confirm the name, department, email and address you would like this to be sent to:
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Date
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Submit
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