Request For Mediation

MTI EAST AFRICA MEDIATION CENTRE

MEDIATION REQUEST FORM

Have all the parties agreed to mediate this matter? *

Remarks

Please Read

Parties who wish to apply for mediation under MTI EA Mediation Centre Rules must complete this Request for Mediation form.
Please copy all the relevant parties to the dispute when sending the Request for Mediation to MTI East Africa.

Fee

Please note that the non-refundable filing fee of Kshs 50,000 (inclusive of VAT) per party will be payable within three (3)working days after MTI East Africa acknowledges the receipt of this Request.
MTI EA will process this request upon full payment of the filing fee

Details of Parties

Note; Where there are more than 2 parties, please provide the details for them in a separate Attachment

Applicants

Applicants Particulars *

Email Address *

Address *

Applicants Contact Particulars *

Contact Number *

Respondents

Respondents Particulars *

Address

Respondent Contact Particulars *

Contacts

Details of Dispute

Quantum of Claim (Ksh)

Quantum of Counter claim (Ksh)

Others *

Type of Dispute

Available Dates for Mediation

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

Date Option 1 *

Date Option 2

Mediator Preferences

(Please note that when parties choose their own mediator, the selected Mediator(s) is/are entitled to charge his/her commercial rates. MTI E.A 's published Fee Schedule will not be applicable)

Mediators Preference Selection

Mediator Background / Attributes

Signature

Applicates Name (Full names)

Application Date

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Overview

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