Commercial – Fiji Mediation Centre

Have all the parties agreed to mediate this matter?

Yes
No

Please Read

Parties who wish to apply for mediation under the Fiji Mediation Centre (FMC) Commercial Mediation Scheme (the Scheme) must complete this Request for Mediation. This Scheme is applicable to matters where the total quantum of claim and counterclaim exceed FJ$....... Please copy all the relevant parties to the dispute when sending the Request for Mediation to FMC.

Filing Fee

Please note that the non-refundable filing fee of of FJ$218.00 (inclusive of VAT) per party will be payable within three (3) working days after FMC acknowledges the receipt of this Request. FMC will process this request upon full payment of the filing fee.

Details of Parties

(Where there are more than 2 parties or law firms, please provide the details for them in a separate attachment)This Scheme is applicable to matters where the total quantum of claim and counterclaim exceed FJ$.......

Suit Number:

(if applicable)

Applicant(s)

If court proceedings have started, please tick the applicable box:

Plaintiff
Defendant
Third Party

Contact Particulars

Salutation:

Mr
Mrs
Ms
Others

(if applicable)

Name:

First Last

Address:

Street Address City

(If not legally represented)

Contact No:

(If not legally represented)

Email Address:

(If not legally represented)

Contact Particulars

(Legal Representatives)

Salutation:

Mr
Mrs
Ms
Others

(if applicable)

Name

First Last

Law Firm

Address:

Street Address City

(If not legally represented)

Contact No:

(If not legally represented)

Email Address:

(If not legally represented)

Reference Number:

Respondents

If court proceedings have started, please tick the applicable box:

Plaintiff
Defendant
Third Party

Contact Particulars

Salutation:

Mr
Mrs
Ms
Others

(if applicable)

Name

First Last

Address:

Street Address City

(If not legally represented)

Contact No:

(If not legally represented)

Email Address:

(If not legally represented)

Contact Particulars

(Legal Representatives)

Salutation:

Mr
Mrs
Ms
Others

(if applicable)

Name

First Last

Law Firm

Address:

Street Address City

(If not legally represented)

Contact No:

(If not legally represented)

Email Address:

(If not legally represented)

Reference Number:

Details of Dispute

Quantum of claim:

Quantum of counterclaim:

(Please be aware that your claim cannot be more than FJ$....... to qualify for this scheme)

Others:

Type of Dispute

Please provide brief details of the dispute:

Available dates for mediation

Please provide a few available dates - if possible, mutually agreed dates:

Mediator Preferences

Parties wish to choose their own Mediator(s): (Please note that when parties choose their own mediator, the selected Mediator(s) is/are entitled to charge his/her commercial rates. FMC’s published Fee Schedule will not be applicable)

Name(s):

OR Parties wish for FMC to appoint appropriate Mediators:

1 Mediator
2 Mediators

Mediator Background / Attributes*:

[ie industry, profession, language proficiency, age, etc]

Signature

Applicant’s Name and Signature:

Date:

How did you hear about us?

Official Use

Nature of Dispute:

Domestic
International