Request for MediationSmall Case Mediation SchemeDownload PDF FormHave all the parties agreed to mediate this matter?YesNoPlease ReadParties who wish to apply for mediation under the Fiji Mediation Centre (FMC) Small Case Commercial Mediation Scheme (the Scheme) must complete this Application Form. FMC reserves the right to reject any Application. This Scheme is applicable to matters where the total quantum of claim and counterclaim exceed FJ$.......Details of Parties(Where there are more than 2 parties or law firms, please provide the details for them in a separate attachment)This Scheme is applicable to matters where the total quantum of claim and counterclaim exceed FJ$.......Suit Number:(if applicable)If court proceedings have started, please tick the applicable box: Plaintiff Defendant Third PartyApplicant(s)I am applying:As an individualFor an organizationContact ParticularsSalutation:MrMrsMsOthers(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:MrMrsMsOthers(if applicable)Name First Last Law FirmAddress: Street Address City (If not legally represented)Contact No:(If not legally represented)Email Address: (If not legally represented)Reference Number:RespondentsIf court proceedings have started, please tick the applicable box: Plaintiff Defendant Third PartyIf not, my counter party is: As an individual For an organizationContact ParticularsSalutation:MrMrsMsOthers(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:MrMrsMsOthers(if applicable)Name First Last Law FirmAddress: Street Address City (If not legally represented)Contact No:(If not legally represented)Email Address: (If not legally represented)Reference Number:Details of DisputeThe Value of claim:Quantum of counterclaim:(Please be aware that your claim cannot be more than FJ$....... to qualify for this scheme)Others:Type of Dispute Agency Banking/Financial Instruments Company / Shareholders Information Technology Construction/Contractors Defamation Employment Family/Neighbour Insurance Intellectual Property/Trademarks/Copyright Joint Venture/Partnership Personal Injury Probate (Deceased) Professional Malpractice Renovation Sale & Purchase of Property Sale/Supply of Goods & Services/Title of Goods Sports Shipping Tenancy Torts Trust OthersPlease provide brief details of the dispute:Available dates for mediationPlease provide a few available dates - if possible, mutually agreed dates:Terms and ConditionsTerms and Conditions(1) A mediation fee deposit is payable to FMC by each party within three working days after FMC has confirmed the date of mediation. In the event that the mediation is aborted after FMC has confirmed the date of Mediation, FMC has the right to keep any part or all of the mediation fee deposit paid by both parties. (2) Mediation under this Scheme will be scheduled either on a weekday or Saturday, depending on the availability of the mediator, parties and venue. (3) If the total value of the claim is revised to above FJ$.... before or during the mediation session, FMC reserves the right to revise the mediation fee payable by parties.SignatureApplicant’s Name and Signature:Date:How did you hear about us? Industry/ Business Network Lawyer’s Referral Media (Newspaper, television etc.) Mediation Clause (If so, please annexe a copy of the Mediation Clause to your Request for Mediation.) FMC Invitation Letter FMC Website The High Court of Fiji : ADR Offer (High Court Practice Direction) Referral from Master/ Judicial Officer Referral from High Court The State Courts of Fiji Telephone Enquiry to FMC OthersΔ
