Annexure 29 — CONSULT_MANUAL

1. Name 2. Contact Details: 3. I hereby certify that I have retired from (Organisation/ Unit) w.e.f. _______in______grade.

I hereby certify that I am serving Officer and am presently posted as______ in grade. Or I hereby certify that I am currently empanelled as arbitrator by Indian Council for Arbitration (ICA) in the category of ___________.

4. I have no past or present relationship in relation to the subject matter in dispute, whether financial, business, professional or other kind.

I have past or present relationship in relation to the subject matter in dispute, whether financial, business, professional or other kind. The list of such interests is as under:

5. I have no past or present relationship with or interest in any of the parties whether financial, business, professional or other kind, which is likely to give rise to justifiable doubts as to my independence or impartiality in terms of the Arbitration and Conciliation Act 1996.

I have past or present relationship with or interest in any of the parties whether financial, business, professional or other kind, which is likely to give rise to justifiable doubts as to my independence or impartiality in terms of the Arbitration and Conciliation Act 1996. The details of such relationship or interest are as under:

6. There are no concurrent circumstances which are likely to affect my ability to devote sufficient time to the arbitration and in particular to finish the entire arbitration within twelve months.

There are circumstances which are likely to affect my ability to devote sufficient time to the arbitration and in particular to finish the entire arbitration within twelve months. The list of such circumstances is as under:

(Name ----------------------)

Annexure 29: Format of Declaration by the Appointed Arbitrator (Refer para 10.7.9-3-d)-i),ii)) (On Letterhead of Arbitrator)