Request for Mediation

CLAIMANT DETAILS

Claimant's Name:

Please add the name precisely as it should appear in the case caption.

Claimant's Nationality:

Additional Claimants' Names:

Please add any additional names precisely as they should appear in the case caption.

Additional Claimants' Nationalities:

Please add the nationality next to each additional Claimant name.

ID / Commercial Register Number:

Address Line 1:

Address Line 2:

Address Line 3:

P.O. Box:

City:

Post Code:

State/Province:

Country:

National Address:

(applicable only for Saudi Arabia)

Telephone Number:

Email Address:

Representative Name:

If you are an individual and represent yourself, please add your name and contact details in this and the following boxes. If the claimant is a legal person, please add the name of its authorized representative.

Representative Firm Name:

(if applicable)

Representative Address Line 1:

Representative Address Line 2:

Representative Address Line 3:

Representative P.O. Box:

Representative City:

Representative Post Code:

Representative State/Province:

Representative Country:

Representative National Address:

(applicable only for Saudi Arabia):

Representative Telephone Number:

Representative Mobile Number

Representative Email Address:

DISPUTE DETAILS

Date of Contract or Mediation Agreement:

Please provide the date of the contract that includes the mediation clause (or the date of the mediation agreement, if separate from the contract):

dd/mm/yyyy

Text of Mediation Clause/Agreement:

Please copy and paste the language of the mediation clause (or mediation agreement) in the below box.

Nature of the Dispute:

Please describe the dispute in adequate detail. The description should include the factual background of the dispute, the relation between parties whether contractual or non-contractual, the legal position of the parties and the relief or remedies sought. You may also summarize the dispute in the below box and upload a more detailed Statement of Claim.

Claim or Relief Sought:

(e.g., claim amount, declaratory relief, etc.)

Claimant Type of Business:

Respondent Type of Business:

Number of Mediators:

Place of Mediation:

Language:

Requested Mediator Qualifications:

If the parties have already agreed on a Mediator, please provide his/her name and contact details.

RESPONDENT DETAILS

Respondent's Name:

Please add the name precisely as it should appear in the case caption.

Respondent’s Nationality:

Additional Respondents' Names:

Please add any additional names precisely as they should appear in the case caption.

Additional Respondents' Nationality:

Please add the nationality next to each additional Respondent name.

ID / Commercial Register Number:

Address:

P.O. Box:

City:

Post Code:

State/Province:

Country:

National Address:

(applicable only for Saudi Arabia)

Telephone Number:

Email Address:

Representative Name:

If the respondent is self-represented, please add the respondent’s name and contact details in this and the following boxes. If the respondent is a legal person, please add, if known, the name of its authorized representative.

Representative Firm Name:

(if applicable)

Representative Address:

Representative P.O. Box:

Representative City:

Representative Post Code:

Representative State/Province:

Representative Country:

Representative National Address:

(applicable only for Saudi Arabia)

Representative Telephone Number:

Representative Mobile Number:

Representative Email Address:

ACKNOWLEDGEMENTS

I agree.

The information provided herein, and any attachments thereto, are true and accurate to the best of my knowledge and belief. If there is any change in the information provided, I agree to promptly notify the SCCA.

I agree.

I understand that to start a mediation proceeding, all filing requirements pursuant to Article 3 of the SCCA Mediation Rules must be satisfied. This includes the information requested in this Request for Mediation, the contract including the mediation clause or a separate mediation agreement, and the appropriate filing fee. I understand that if the filing requirements cannot be met within 10 days from the date I have submitted this form, the SCCA may discontinue the processing of my incomplete filing without prejudice. I may then refile my claim once I can satisfy all filing requirements subject to any applicable laws and regulations.

I agree.

I understand that this proceeding shall commence once also the appropriate filing fee (see Article 2 of Appendix Mediation Costs and Fees to the SCCA Mediation Rules) has been received by the SCCA. The SCCA will provide an invoice and payment instructions under separate cover shortly.

I agree.

I understand that I will receive a copy of this Request for Mediation after I have clicked the below “SUBMIT” button. I agree to forward this Request for Mediation, along with the contract and any other documents provided to the SCCA, to the respondent(s) as per Article 3 of the SCCA Mediation Rules.

I agree.

I agree to receive any and all SCCA communications pertaining to my case via email.

I agree.

I agree to receive selected SCCA communications pertaining to my case via text message.

I agree.

I have read the SCCA’s Terms and Conditions (https://sadr.org/terms-condition?lang=en) and commit to uphold and respect their provisions at all times.

I agree.

Optional: I authorize the SCCA to use the information I have provided in this form for purposes of marketing communications.

I agree.

DOCUMENT UPLOAD

Please upload your documents here:

Please upload your contract and any other supporting documents. You may upload up to 10 documents, preferably in PDF-format. Each upload shall not exceed 30 MB.

Drop your files here

I confirm that I have uploaded the contract including the mediation clause or, where applicable, the mediation agreement.

Where applicable, I confirm that I have uploaded a Power of Attorney.

Complete and Submit:

The parties will receive an official letter initiating this proceeding once all filing requirements have been satisfied.

Send me a copy of my responses

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