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REQUEST FOR THE APPOINTMENT OF A MEDIATOR

    Guidance Note - Prior to completing the application:

    Please complete this application form and click 'Submit'. If you would like to discuss your application with somebody within our Dispute Resolution team, please email [email protected]

    ​Please complete this form by typing in the required fields. 

    Please view the 'Schedule of Fees for all Cases' on our website regarding the application fee www.primedispute.com 
    ​

    This application form is the contract between the applicant and Prime Dispute. Prime Dispute will rely entirely upon the information contained herein to help select a Mediator. The information submitted on this application is accepted as being accurate and complete. Neither Prime Dispute or the appointed Mediator accept liability in relation to the appointment, if the information provided is inaccurate or incomplete.

    Please do not complete this form if you don't want Prime Dispute to collect, store, share with the Mediator and process your information. Please note - Prime Dispute will give careful consideration to any representations, but will reach its own decision as to who is appointed.

    REQUESTING THE APPOINTMENT OF* (PLEASE SELECT AS APPROPRIATE):  
    Select the neutral you require. If you are unsure about the terms please visit our 'Library'.
    INFORMATION ABOUT THE  DISPUTE

    PARTIES & THEIR REPRESENTATIVES 
    Prime Dispute will take reasonable steps to ensure that the appointed Mediator is free from conflict of interests. It is therefore essential that you provide details of the parties and their representatives.

    The parties representatives must be stated. Where a party is unrepresented, please ensure email addresses are included (if you have a direct contact number, please also include this). Communications from Prime Dispute are sent by email. Therefore, it is important you provide email addresses.
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    AGREEMENT 
    Please agree to either part A or B below:
    Max file size: 20MB
    FEE 
    PRIVACY
    Prime Dispute takes the privacy and security of the personal information you provide seriously. Your details are held in a secure database with access provided to senior Prime Dispute Executives only. We apply data processing policies in compliance with the Data Protection Act 2018. Prime Dispute will not use the information you provide in this request to contact you with offers of products and services. Prime Dispute will not share your information with third parties for the purpose of sending you details of offers of products or services. Please read our Terms and Conditions on our website.
    ​FINAL STAGE - APPLICATION SUBMITTED BY: 
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    Max file size: 20MB
    Max file size: 20MB
    Max file size: 20MB
    Max file size: 20MB
Submit
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About Prime Dispute 
​
Prime Dispute / Is a global membership organisation for qualifications and standards in law, dispute avoidance, management & resolution 


Our purpose / Helping industry create a more prosperous and conflict free working world.

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Please email all correspondence to [email protected] 
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