AFSA Mediators Panel Questionnaire
Mediator Information Questionnaire
BASIC INFORMATION
Title
Name
(Required)
First
Last
Email
(Required)
Cell Number
Preferred Salutation (if different):
Gender:
Nationality:
Additional Nationalities (if any):
Date of Birth (optional, for demographic statistics):
CONTACT DETAILS
Main Email Address:
Alternate Email (if applicable):
Office Phone Number:
Mobile/Cell Number:
LANGUAGES SPOKEN
Please list all languages in which you are professionally fluent
Language 1 (Primary):
Language 2:
Language 3:
Language 4:
Language 5:
PROFESSIONAL PROFILE
Current Professional Position / Organisation:
Profession (e.g. Arbitrator, Counsel, Engineer, Academic, Judge):
Other Relevant Roles or Affiliations (e.g. Professor, Board Member, etc.):
LEGAL AND TECHNICAL BACKGROUND
Legal Background / Area of Legal Training (e.g. Common Law, Civil Law, Mixed):
Primary Area(s) of Legal Expertise (e.g. Construction Law, Energy, International Commercial Law):
Sector Expertise / Industry Specialisation (tick or list):
Construction
Infrastructure
Energy / Natural Resources
Criminal
Mining
Financial Services
Maritime / Shipping
Intellectual Property
Technology / Telecoms
Labour
Commercial Contracts
Insurance
Insolvency
Other (please specify):
Please specify
SHORT PROFILE / BIO (for public listing)
Please provide a brief (max 200 words) professional profile/bio for publication in the AFSA Panel Directory
ADDITIONAL INFORMATION / COMMENTS
Is there anything else you’d like to share or clarify regarding your background, availability, or areas of interest?
COURT ANNEXED MEDIATIONS
Have you completed a 40-hour mediation course provided by AFSA or any other a Recognised Mediation Organisation (RMO)
If the course was not provided by AFSA kindly indicate the RMO and attach proof thereof
Have you been issued with a certificate of competence by AFSA or any other RMO. If not AFSA please specify the RMO.
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