Declaration of impartiality and independence



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ARBITRATION
AND
MEDIATION CENTER

ANNEX B
DECLARATION OF IMPARTIALITY AND INDEPENDENCE


Before making a panelist appointment, the Center checks with each prospective panelist whether there are any facts or circumstances, past or present, or that could arise in the foreseeable future, that might call in to question that person’s independence in the eyes of one or both of the parties in the administrative proceeding.
Taking in to consideration the envisioned procedural schedule in a case, the Center also checks whether the prospective panelist is able to commit the time required to discharge his or her duties responsibly and within the required deadlines.
Finally, the Center requires all prospective panelists to complete and submit a Statement of Acceptance and Declaration of Impartiality and Independence.






STATEMENT OF ACCEPTANCE

AND

DECLARATION OF IMPARTIALITY AND INDEPENDENCE

Case Number:
I, the undersigned,
___________________________________ Last Name, First Name(s)
[ ] hereby declare that I accept to serve as a Panelist under the Domain Name Dispute Resolution Policy for .AE and the Rules Domain Name Dispute Resolution Policy for .AE (the Rules), approved by UAEnic, and the WIPO Arbitration and Mediation Center’s Supplemental Rules for Domain Name Dispute Resolution Policy for .AE (the Supplemental Rules). By making this declaration, I confirm that I have familiarized myself with the principles, standards, requirements and fees set out in the aforementioned instruments and that I am available to serve as a Panelist in accordance therewith. I further declare that, by accepting to serve as a Panelist in this case, I shall execute my responsibilities honestly, fairly and within the time periods required by the Rules and Supplemental Rules.
Please check the appropriate box below, taking into consideration, inter alia, whether there exists any past or present relationship, direct or indirect, with either of the parties or any of the registrars, whether financial, professional or of another kind and whether the nature of any such relationship is such that disclosure is called for. [Any doubt should be resolved in favor of disclosure].
[ ] I am independent of each the parties and the concerned registrar(s). To the best of my knowledge and belief, there are no facts or circumstances, past or present, or that could arise in the foreseeable future, that need be disclosed as they might be of a such a nature as to call in to question my independence in the eyes of one or both of the parties.
[ ] I am independent of each of the parties and the concerned registrar(s). However, I wish to disclose the circumstances described in the attachment hereto (attach separate sheet) as they might be of such a nature as to call in to question my independence in the eyes of one or both of the parties.
[ ] hereby declare that I decline to serve as a Panelist in the present case. (Disclosure of the reasons for declining to accept the appointment should be made on a separate sheet and attached hereto.)

Place: ____________________ Signature: _______________________


Date: ____________________


34, chemin des Colombettes

1211 Geneva 20, Switzerland

T +4122 338 82 47 F +4122 740 37 00

domain.disputes@wipo.int



www.wipo.int/amc


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