PANELLIST REGISTRATION FORM: CONTRACTUAL ADJUDICATION

Acknowledgement

By submitting this Registration Form, you authorise NZDRC to:

  • retain and record any personal information provided in connection with NZDRC; and
  • collect, store, use, and disclose information about you for any purpose relating to NZDRC's services, including but not limited to:
    • performing the services provided by NZDRC generally;
    • marketing;
    • research; and
    • compliance with all applicable laws and regulations.
Under the Privacy Act 1993 you have the right to access your personal information recorded by us and have it updated or corrected. If you have any questions about the privacy and security of your personal information, please contact us.

Please note that, at any time the information provided in this Registration Form becomes outdated or otherwise incorrect, you must notify the Registrar immediately.

Note: if you have already completed an NZDRC Registration Form which provides all of the information sought in the Adjudication Panel Registration Form below, please simply complete the Declaration below. Otherwise, proceed straight to the Adjudication Panel Registration Form.

 
Declaration
I have completed an NZDRC Registration Form with respect to another panel and confirm that all details requested below have been provided and remain up to date.*
I confirm.
Name*
Email:*
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Adjudication Panel Registration Form

Please review the form below before beginning to complete it to ensure you have all the necessary information to hand. You will not be able to save and return to the form to complete it later.

CONTACT INFORMATION
1. Name:*
2. Company Name (if applicable):
3. Postal Address:*
4. Service Address:*
5. Email:*
6. Phone:*
7. Mobile:
LANGUAGES
8. Please select the languages in which you are fluent:
English
te reo Maori
NZ Sign Language
Samoan
Hindi
Mandarin
Cantonese
French
German
Spanish
Other
If you selected other above, please expand:
EDUCATION/PROFESSIONAL SUPERVISION
9. Post Nominals:
10. Professional Memberships:
11. Have you ever been charged with professional misconduct by a professional body or association or been subject to disciplinary action?*
Yes
No
If yes, please explain:
12. Have you ever been convicted of a criminal offence?*
Yes
No
If yes, please explain:
AREAS OF SPECIALISATION
13. Please identify any areas of specialisation:
Commercial
Insurance
Property
Financial Services
Employment
Shareholder
Valuation
IT
Intellectual Property
Public Sector
Consumer
Trusts
International Commercial
Family and Relationship
Building and Construction
Other
If you selected other above, please expand:
PAYMENT DETAILS
14. Bank Account Number:*
This is the account into which you instruct NZDRC to make any payments to you. It is your responsibility to make sure this is updated with the Registry staff immediately should your account details change. Where you fail to advise any changes, NZDRC will assume no liability to you for any loss which may result.
15. I am GST registered:*
Yes
No
GST Number:
All New Zealand based panellists must be GST registered.
WEBSITE PROFILE
16. I wish to continue to use the bio currently on NZDRC's website:*
Yes
No
If no, please upload a copy of your current bio for inclusion on your panellist page.
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Uploading Files

Your bio/cv should not exceed 400 words. Please note that the inclusion of any bio/cv information is subject to the review and approval of NZDRC.
17. I wish to continue to use the photo currently on NZDRC's website:*
Yes
No
If no, please upload a high resolution photo for inclusion on your panellist page.
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Uploading Files

Please note your photo will need to be 200 pixels square and will be cropped to fit if necessary.
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ABOUT US

Fair, prompt and cost effective conflict management and dispute resolution services. Proudly serving industry, commerce and the community for 25 years.

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