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Form 1a - Application For Ncia Arbitrator Panel Status - Nairobi Centre For International Arbitration Page 3

Nairobi Centre for International Arbitration - NCIA Arbitrator Panel Status Standard

c) Are you a certified/accredited Arbitrator or listed in the panel of any other

arbitral/Arbitration institution? YES/NO

If yes, provide particulars_____________________________________________________

d) Whether currently Arbitration is your primary (full-time) practice? ____________________________

4. OTHER INFORMATION

a) Outline any other relevant experience or provide any other information which supports

your application (including where your Arbitration experience involves disputes of an

international character).

b) What is your preferred area(s) of practice as a Arbitrator?______________________________________

5. DECLARATION

I understand the Nairobi Centre for International Arbitration does not provide employment for any

Arbitrator. I also understand the decision to nominate or appoint an Arbitrator or Arbitrators to

any Arbitration referred to Nairobi Centre for International Arbitration is within the exclusive

discretion of the Nairobi Centre for International Arbitration.

I __________________________________________________________________ hereby declare that the information

provided herein is complete and accurate. I understand that a false statement may disqualify my

application from consideration and I hereby give my consent to a personal investigation in

connection with this application for NCIA Arbitrator Panel Status.

Signature of Applicant: ________________________ Date: ___________________________

(Please attach to the application recommendation by two references who attest to your Arbitration

)

experience. A certified/notarised Identification Document for the Referee must be attached.

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Form 1a - Application For Ncia Arbitrator Panel Status - Nairobi Centre For International Arbitration Page 3