APPLICATION FOR MEDIATION PROGRAM


Name and contact details of person completing form:

Details of your solicitor (if you are legally represented):

I confirm that all parties to the dispute agree to this application for mediation:

Please provide the name of any other parties to the dispute:

Court Details (if applicable):

Details of Party 2 (if legally represented, please provide details of solicitor)
Details of Party 3 (if legally represented, please provide details of solicitor):