HKMAAL

Section A - Applicant's background information

Salutation

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Sex

:

Surname (Chinese)

:

First Name (Chinese)

:

Surname (English)

:

First Name (English)

:

Nationality

:

Place of Ordinary Residence

:

Email Address

:

Mobile No.

:

Correspondence Address

:

Language (may tick multiple boxes)

:

Putonghua

English

Cantonese

Portuguese

Other language

Profession / Occupation (may tick multiple boxes)

:

Legal (Solicitor)

Legal (Barrister)

ADR Practitioner (non-practising lawyer)

ADR Practitioner (Arbitrator)

ADR Practitioner (Mediator)

ADR Practitioner (Loss Adjuster)

ADR Practitioner (Claim Specialist)

Banking, Accounting or Finance

Insurance or Financial Advisory

Architect, Engineer or Surveyor

Registered Medical Practitioner

Government and Public Services

Information Technology

Welfare and Social Work

Commerce, Sales and Marketing Promotion

Administration and Management

Real Estate or Property Management

Education and Training

Science and Research

Psychology and Counselling

Retired

Others

Job Title

:

Working Organisation

:

Are you currently an accredited mediator with any mediation organization, whether international, from Mainland China, or from Macau?

:

Are you currently a Specially Invited Mediator by a People's Court in Mainland China?

:

Section B - Qualification Requirements for Accreditation as a GBA Mediator:

Successful completion of the designated GBA Mediator Training Course :

A. Regarding Mediation Training Course:

I have not completed any HKMAAL- accredited mediation training course

I have completed a HKMAAL- accredited mediation training course of a duration of not less than 40hrs in

I have become an HKMAAL Accredited Mediator through the grandparenting policy

B. Regarding the GBA Mediator Training Course of Hong Kong designated by the Department of Justice of the Hong Kong SAR Government.

I have not completed the GBA Mediator Training Course of Hong Kong designated by the Department of Justice of the Hong Kong SAR Government.

I have completed the GBA Mediator Training Course of Hong Kong designated by the Department of Justice of the Hong Kong SAR Government in

Possessing at least FIVE (5) years of full-time work experience:

Work Experience1:
1. Time (From)		2. Time (Till)
3. Employer Self-employed Employed
4. Job Title
5. Job Description
6. Upload Supporting Document (only image files in .JPG or .PDF of not more than 5mb in size)

Work Experience2:
1. Time (From)		2. Time (Till)
3. Employer Self-employed Employed
4. Job Title
5. Job Description
6. Upload Supporting Document (only image files in .JPG or .PDF of not more than 5mb in size)

Work Experience3:
1. Time (From)		2. Time (Till)
3. Employer Self-employed Employed
4. Job Title
5. Job Description
6. Upload Supporting Document (only image files in .JPG or .PDF of not more than 5mb in size)

Commencement and Completion of mediation in at least FIVE (5) cases within FIVE(5) years immediately prior to this application:

In relation to each completed mediation cases:

Case 1:

1. Year and Month of the mediation

2. Please describe the identities of both parties (e.g., government departments, listed companies, individuals, etc.)

3. Jurisdiction(s) involved for the parties and the subject matter of the dispute

4. Amount in dispute or non-monetary relief

5. Brief Description of the Dispute
(Please provide a summary of at least 200 words but no more than 400 words regarding the background of the dispute, the legal issues involved, preparations before the mediation meeting, the number of mediation meetings conducted and the format of the mediation meetings (e.g., in-person or online), and other special features (such as cross-border disputes), etc.)

6. Language(s) of the mediation

7. Mediation outcome
(Please provide a summary of at least 200 words but no more than 400 words on whether the mediation resulted in a full or partial settlement, the impact of the mediation on any potential or ongoing litigation or arbitration, whether the applicant as the mediator has participated in drafting the settlement agreement, etc.)

8. Duration of the mediation

Preparation before the mediation:	Hour(s)		Drafting the settlement agreement (if any):	Hour(s)
Mediation meeting(s):	Hour(s)		Other mediation-related work:	Hour(s)

9. Number of mediators involved:

10. Whether the applicant is a sole mediator or a co-mediator

11. Please upload a proof of the mediation case (including but not limited to: agreement to mediate, mediator appointment letter, etc.) with sensitive information redacted (only image files in .JPG or .PDF of not more than 5mb in size)

Case 2:

1. Year and Month of the mediation

2. Please describe the identities of both parties (e.g., government departments, listed companies, individuals, etc.)

3. Jurisdiction(s) involved for the parties and the subject matter of the dispute

4. Amount in dispute or non-monetary relief

5. Brief Description of the Dispute
(Please provide a summary of at least 200 words but no more than 400 words regarding the background of the dispute, the legal issues involved, preparations before the mediation meeting, the number of mediation meetings conducted and the format of the mediation meetings (e.g., in-person or online), and other special features (such as cross-border disputes), etc.)

6. Language(s) of the mediation

7. Mediation outcome
(Please provide a summary of at least 200 words but no more than 400 words on whether the mediation resulted in a full or partial settlement, the impact of the mediation on any potential or ongoing litigation or arbitration, whether the applicant as the mediator has participated in drafting the settlement agreement, etc.)

8. Duration of the mediation

Preparation before the mediation:	Hour(s)		Drafting the settlement agreement (if any):	Hour(s)
Mediation meeting(s):	Hour(s)		Other mediation-related work:	Hour(s)

9. Number of mediators involved:

10. Whether the applicant is a sole mediator or a co-mediator

11. Please upload a proof of the mediation case (including but not limited to: agreement to mediate, mediator appointment letter, etc.) with sensitive information redacted (only image files in .JPG or .PDF of not more than 5mb in size)

Case 3:

1. Year and Month of the mediation

2. Please describe the identities of both parties (e.g., government departments, listed companies, individuals, etc.)

3. Jurisdiction(s) involved for the parties and the subject matter of the dispute

4. Amount in dispute or non-monetary relief

5. Brief Description of the Dispute
(Please provide a summary of at least 200 words but no more than 400 words regarding the background of the dispute, the legal issues involved, preparations before the mediation meeting, the number of mediation meetings conducted and the format of the mediation meetings (e.g., in-person or online), and other special features (such as cross-border disputes), etc.)

6. Language(s) of the mediation

7. Mediation outcome
(Please provide a summary of at least 200 words but no more than 400 words on whether the mediation resulted in a full or partial settlement, the impact of the mediation on any potential or ongoing litigation or arbitration, whether the applicant as the mediator has participated in drafting the settlement agreement, etc.)

8. Duration of the mediation

Preparation before the mediation:	Hour(s)		Drafting the settlement agreement (if any):	Hour(s)
Mediation meeting(s):	Hour(s)		Other mediation-related work:	Hour(s)

9. Number of mediators involved:

10. Whether the applicant is a sole mediator or a co-mediator

11. Please upload a proof of the mediation case (including but not limited to: agreement to mediate, mediator appointment letter, etc.) with sensitive information redacted (only image files in .JPG or .PDF of not more than 5mb in size)

Case 4:

1. Year and Month of the mediation

2. Please describe the identities of both parties (e.g., government departments, listed companies, individuals, etc.)

3. Jurisdiction(s) involved for the parties and the subject matter of the dispute

4. Amount in dispute or non-monetary relief

5. Brief Description of the Dispute
(Please provide a summary of at least 200 words but no more than 400 words regarding the background of the dispute, the legal issues involved, preparations before the mediation meeting, the number of mediation meetings conducted and the format of the mediation meetings (e.g., in-person or online), and other special features (such as cross-border disputes), etc.)

6. Language(s) of the mediation

7. Mediation outcome
(Please provide a summary of at least 200 words but no more than 400 words on whether the mediation resulted in a full or partial settlement, the impact of the mediation on any potential or ongoing litigation or arbitration, whether the applicant as the mediator has participated in drafting the settlement agreement, etc.)

8. Duration of the mediation

Preparation before the mediation:	Hour(s)		Drafting the settlement agreement (if any):	Hour(s)
Mediation meeting(s):	Hour(s)		Other mediation-related work:	Hour(s)

9. Number of mediators involved:

10. Whether the applicant is a sole mediator or a co-mediator

11. Please upload a proof of the mediation case (including but not limited to: agreement to mediate, mediator appointment letter, etc.) with sensitive information redacted (only image files in .JPG or .PDF of not more than 5mb in size)

Case 5:

1. Year and Month of the mediation

2. Please describe the identities of both parties (e.g., government departments, listed companies, individuals, etc.)

3. Jurisdiction(s) involved for the parties and the subject matter of the dispute

4. Amount in dispute or non-monetary relief

5. Brief Description of the Dispute
(Please provide a summary of at least 200 words but no more than 400 words regarding the background of the dispute, the legal issues involved, preparations before the mediation meeting, the number of mediation meetings conducted and the format of the mediation meetings (e.g., in-person or online), and other special features (such as cross-border disputes), etc.)

6. Language(s) of the mediation

7. Mediation outcome
(Please provide a summary of at least 200 words but no more than 400 words on whether the mediation resulted in a full or partial settlement, the impact of the mediation on any potential or ongoing litigation or arbitration, whether the applicant as the mediator has participated in drafting the settlement agreement, etc.)

8. Duration of the mediation

Preparation before the mediation:	Hour(s)		Drafting the settlement agreement (if any):	Hour(s)
Mediation meeting(s):	Hour(s)		Other mediation-related work:	Hour(s)

9. Number of mediators involved:

10. Whether the applicant is a sole mediator or a co-mediator

11. Please upload a proof of the mediation case (including but not limited to: agreement to mediate, mediator appointment letter, etc.) with sensitive information redacted (only image files in .JPG or .PDF of not more than 5mb in size)

Possessing at least THREE (3) years of work experience as a mediator:

I have not been accredited as a mediator for at least Three (3) years

I have been accredited as a HKMAAL Mediator for at least Three (3) years

I have been enlisted as a mediator on the panels of other mediation organisations for at least three (3) years (please upload supporting information on the time period acting as a panel mediator, along with other relevant proof). I hereby authorise and provide consent to HKMAAL for conducting verification and related follow-up work with the relevant mediation organisation(s). (only image files in .JPG or .PDF of not more than 5mb in size)

I have worked as a mediator in my personal capacity for at least Three (3) years (please upload supporting documents). (only image files in .JPG or .PDF of not more than 5mb in size)

To seek exemption from one or more of the above qualification requirements:

I do not need to seek for any exemption.

I wish to seek for an exemption from the following selected qualification requirements and will submit a written request via email to info@hkmaal.org.hk, along with all the supporting documents (including but not limited to the applicant’s outstanding achievements and significant contributions in the field of mediation):

At least 5 years of full-time work experience

Commencement and completion of at least Five (5) mediation cases within the Five (5) years immediately prior to this application

At least 3 years of work experience as a mediator

Successful completion of the designated GBA Mediator Training Course

Section C: Personal Data Collection Statement

1. Purpose of Data Collection: Hong Kong Mediation Accreditation Association Limited (hereinafter referred to as “HKMAAL”) may use the applicant's personal data for the following
(i) To contact the applicant;
(ii) To allow HKMAAL, the Department of Justice of the HKSAR, and/or other relevant departments and organisations to review, follow up, and process the applicant’s application as required;
(iii) To allow HKMAAL, the Department of Justice of the HKSAR, and/or other relevant departments and organisations to disclose to the public the list of approved Guangdong-Hong Kong-Macao Greater Bay Area Mediators (where the application is reviewed and endorsed by the Guangdong-Hong Kong-Macao Greater Bay Area Mediation Working Group and in turn confirmed by the Guangdong-Hong Kong-Macao Bay Area Legal Departments Joint Conference)

2. Impact of Failing to Provide Personal Data: Applicant must provide the personal data and supporting documents required by HKMAAL. If any relevant personal data and supporting documents are not provided, HKMAAL may be unable to process the applicant’s application and reserves the right to decline processing the same.

3. Rights to Access and Correct: Under the Personal Data (Privacy) Ordinance of Hong Kong, applicant has the right to request access to and correction of any personal data provided to HKMAAL. If an applicant wishes to access or correct their personal data, they should submit a written request to the HKMAAL Secretariat.

Section D: Applicant's Declaration and Signature

I hereby declare that:

1. I have perused and understood the "The Greater Bay Area Mediator Accreditation Standards", the "The Greater Bay Area Mediator Accreditation Rules (Hong Kong Special Administrative Region)", as well as the "Personal Information Collection Statement" as detailed in Section C of this Application Form.

2. I shall acknowledge and uphold the “Constitution of the People's Republic of China”, the “Basic Law of the Hong Kong Special Administrative Region of the People's Republic of China”, the “Basic Law of the Macao Special Administrative Region of the People's Republic of China”, and support the "One Country, Two Systems".

3. I shall commit to upholding high standards of professional ethics, and confirm that I have no relevant record of disciplinary actions for disrepute or breach of professional ethics (including disciplinary records from my affiliated mediation organisation and other professional organisations in Hong Kong or abroad). Moreover, I have no criminal records in Hong Kong or aboard, and I am not currently involved in any ongoing criminal legal proceedings in Hong Kong or abroad, nor am I currently involved in any complaint, investigation, or hearing in relation to disciplinary matters by a mediation organization or professional organisation.

4. the information provided in support this Application is complete and accurate, and I authorize the Hong Kong Mediation Accreditation Association Limited (“HKMAAL”) and the Department of Justice of the Hong Kong Special Administrative Region (“DoJ”) to process and review any documents and information provided as required.

5. I understand that, even if this application is accepted by the HKMAAL and/or recommended to the DoJ, neither of these shall confer any right or afford reasonable expectation on my part to be so confirmed as a "Greater Bay Area Mediator" by the Guangdong-Hong Kong-Macao Bay Area Legal Departments Joint Conference.

6. I understand that Guangdong-Hong Kong-Macao Bay Area Legal Departments Joint Conference and the DoJ have the right to, based on actual circumstances, edit or modify the " The Greater Bay Area Mediator Accreditation Standards" and/or the "The Greater Bay Area Mediator Accreditation Rules (Hong Kong Special Administrative Region)".

I confirm that the contents of the above Declaration are accurate and complete

Applicant's English Full Name on Identity Document

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