Mediation e-Form


Number of Parties in Mediation


Contact Details of Your Party and Party’s Counsel

Party's Information

 

Party's Counsel's Information

 

Party's Counsel's Information

 


Other Proceedings if Commenced


Quantum of Dispute


Nature of Dispute

Brief Details of Case

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Agreement to Mediate?



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Desired Duration of Mediation


Preferred Date of Mediation


Mediator

Preferred attributes of the mediator?


Language for Mediation


Venue



Agreement and Declaration

I confirm that all information provided herein is accurate, complete, and true. I agree to provide any further information that is available to me and which SIMC may request in relation to the mediation process. I acknowledge that any false and/or inaccurate information provided in this form may lead to the rejection of the application. I also agree to notify SIMC if any information I have provided becomes untrue, inaccurate or misleading.

Party's Information

 

Party's Counsel's Information

 

Party's Counsel's Information