Privacy Shield Framework – Arbitral Fund

Privacy Shield organizations are required to make a contribution to the Arbitral Fund as part of the registration requirements established by the European Commission and the Department of Commerce.

NOTE: Participating organizations are only required to make ONE INITIAL CONTRIBUTION to the Arbitral Fund. Accordingly, if your organization previously contributed to the fund, no additional payments are required. Any additional contributions into the Arbitral Fund would be required after being contacted in the future by the Department of Commerce. If you have any questions regarding this matter, please contact PrivacyShield@adr.org or call 212-484-3281.

PLEASE ENSURE THE “NAME OF ORGANIZATION” FIELD BELOW MATCHES THE “ORGANIZATION DISPLAY NAME” FIELD ON THE ITA PRIVACY SHIELD WEBSITE DURING THE CERTIFICATION PROCESS

Name of Organization

EIN

D&B/DUNS Number

Address Line 1

Address Line 2

Address Line 3

City

State

ZIP

Organization Contact

First Name

Last Name

Title

Email Address

Confirm Email Address

Phone

Country

Ext.

* indicates mandatory field

Please select one based on the organization's annual revenue

Organization's Annual Revenue

Fund Payment

$0 to $5 million

$250.00

Over $5 million to $25 million

$500.00

Over $25 million to $500 million

$1,000.00

Over $500 million to $5 billion

$5,000.00

Over $5 billion

$10,000.00

* Check here to indicate your agreement that contributions made to the Arbitral Fund of the
Privacy Shield Annex I Binding Arbitration Program are not refundable, in whole or in part.

PrivacyShieldFund (ver 4.4 HA v1)

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