APPLICATION FOR THE FAMILY LAW SETTLEMENT SERVICE ('FLSS')
NAME AND CONTACT DETAILS OF THE PERSON COMPLETING THIS FORM:
Title
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
First Name
*
Last Name
*
Email Address
*
Contact Number
The parties agree to attempt to resolve this dispute by mediation under the FLSS
Yes
No
Name of Party 1
*
Name of Party 2
*
Where 3 or more parties are involved, please give details
COURT:
FILE NUMBER:
Federal Circuit and Family Court of Australia
No proceedings on foot
TYPE OF MATTER:
Parenting
Property
Both
Please attach any relevant court orders:
Browse
IS PARTY 1 REPRESENTED BY A SOLICITOR:
Yes
No
DETAILS OF PARTY 1:
Title
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Full Name
*
Address
Contact Number
Email
*
DETAILS OF SOLICITOR FOR PARTY 1:
Title
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Full Name
*
Firm
Address
Direct Contact Number
Email
*
IS PARTY 2 REPRESENTED BY A SOLICITOR:
Yes
No
DETAILS OF PARTY 2:
Title
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Full Name
*
Address
Contact Number
Email
*
DETAILS OF SOLICITOR FOR PARTY 2:
Title
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Full Name
*
Firm
Address
Direct Contact Number
Email
*
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