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Here you can download the model for the request for mediation
REQUEST FOR MEDIATION
CEPANI npo Belgian Center for Arbitration and Mediation Rue des Sols 8 1000 BRUSSELS
Notifies:
Claimant: (name, first name and complete denomination, quality, address, telephone and fax number, e-mail address, VAT-number)
having as counsel:
Hereinafter named “Claimant”
that it introduces a request for Mediation following the rules of mediation of Cepani, as a result of and until the resolution of the dispute between Claimant and:
Respondent: (name, first name and complete denomination, quality, address, telephone and fax number, e-mail address, VAT-number)
having as counsel:
Hereinafter named “Respondent”
* * *
Following the Rules of Cepina in force as from the 1st of January 2005.
Subject to all rights and without any prejudicial recognition.
* * *
The Request for Mediation is based on the following elements:
I. A RECITAL OF THE NATURE AND CIRCUMSTANCES OF THE DISPUTE GIVING RISE TO THE CLAIM
II. A STATEMENT OF THE RELIEF SOUGHT, A SUMMARY OF THE GROUNDS FOR THE CLAIM, AND IF POSSIBLE, A FINANCIAL ESTIMATE OF THE AMOUNT OF THE CLAIM
III. LANGUAGE OF THE MEDIATION
IV. SEAT OF THE MEDIATION
V. APPLICABLE RULES OF LAW
(date)
(Claimant) (name + quality of the representative
FOR (claimant) its counsel (First Name, Name)
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