Apply for Mediation – Singapore International Mediation Centre (SIMC)

1. Your party's information

Name of Individual or Authorised Representative:

Company:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Counsel Representation:Self-RepresentedRepresented by Law Firm

Number of Law Firms Representing:12

Law Firm 1

1

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Law Firm 2

2

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Number of other parties:1234

2. Other Parties' information

1

Name of Individual or Authorised Representative:

Company:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Counsel Representation:Self-RepresentedRepresented by Law Firm

Number of Law Firms Representing:12

Law Firm 1

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Law Firm 2

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

2

Name of Individual or Authorised Representative:

Company:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Counsel Representation:Self-RepresentedRepresented by Law Firm

Number of Law Firms Representing:12

Law Firm 1

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Law Firm 2

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

3

Name of Individual or Authorised Representative:

Company:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Counsel Representation:Self-RepresentedRepresented by Law Firm

Number of Law Firms Representing:12

Law Firm 1

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Law Firm 2

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

4

Name of Individual or Authorised Representative:

Company:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Counsel Representation:Self-RepresentedRepresented by Law Firm

Number of Law Firms Representing:12

Law Firm 1

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

Law Firm 2

Name of Individual or Authorised Representative:

Name of Law Firm:

Street Address:

City:

Country:

Postal Code:

Contact No:

Email:

3. Other Information

Other proceedings if commenced:LitigationArbitrationOthersNil

Seat:

Others:

Seat:

Others:

Facts of dispute

Quantum of Dispute:

Nature of Dispute:

Brief details of case:

Maximum 1500 characters

Attach any supporting documents:

Agreement to mediate:Parties have agreed to mediate in writing or pursuant to a mediation clause in the contractParties have agreed to mediate but not in writingParties have not agreed to mediate

Attach any supporting documents:

Duration details

Desired duration of mediation:1 Day2 DaysMore

Duration:

Preferred date of mediation:

Did Parties agree on the date(s)?YesNo

Mediator info

Did Parties agree on a mediator?YesNo

Name of Mediator:

Parties agree that SIMC shall appoint the mediator.

Preferred Attributes of the mediator

Nationality

Profession

Language Proficiency

Industry

Mediation style

Co-Mediation?YesNo

Language for mediation:

Venue

Venue for mediation:Parties have agreed to Maxwell Chambers or an SIMC selected venueParties have agreed to choose their own venue