Mediation Application Form | Setting The Bar

Please note: Fields marked with an asterisk (*) must be completed.

Your details:

Your full name *

Your business name *

Your physical address *

Country

City

Your phone numbers *

Your email address *

Your availability to attend STB *

Details of the other party:

Their full name *

Their business name *

Their physical address *

Country

City

Their contact phone numbers *

Their email address *

Their availability to attend STB *

Do they know you are applying to use the STB process? *

Yes

If yes, do they agree to use the STB process *

Yes

n.b., all parties must agree before the STB process takes place.

Are there any other parties who are part of this dispute. If so:

Physical address

Country

City

Phone numbers

Email address

Availability to attend STB

The dispute:

Full name *

Business name *

What is this dispute about? *

(max 500 characters)

What documents do you rely upon? Please attach here:

Who will attend the STB mediation? *

How will they attend the STB mediation? *

Phone

In person

Skype/Zoom

If the STB arbitration is required, who will attend to give evidence/tell the STB arbitrator about the dispute. *

Are there any witnesses that will attend? If so, give witness details, name etc. *

How will your witnesses attend the arbitration process? *

Phone

In person

Skype/Zoom

Are you and the other party sharing the fee of $10.000 plus GST? *

Yes

If no - who is paying it and in what propotion? *

If it is to be shared, in what proportions is the fees to STB being paid? *

Has payment been made? *

(payment must be made in full before the STB process is able to be commence)

Yes

The fee must be paid to your solicitors and held in trust for payment to STB prior to the mediation/arbitration process commencing.

If you do not have a solicitor to hold the funds, then you can send it to Nielsen Law for their trust account number:

Nielsen Law Trust Account Account: 03 1555 0149735 01 Reference: STB and your name

Do you or any of your witness have any disablilities which need to be taken account of? *

(e.g., hearing, inability to get up stairs etc)

Yes

if the answer is yes, what are the details? *

By submitting the application form, you agree and undertake not to bring up with the arbitrator any discussions that were held in the mediation nor will you bring up any offers made by the other party *

I Agree

In order to use the STB process, all parties must agree to the process and must sign the agreement. *

I agree to the STB terms + conditions

Signature

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