APPLY FOR FAMILY LAW ARBITRATION

Before submitting your application form please ensure:

1. You have read and understood our Arbitration Agreement

2. The other party is aware that you wish to submit your dispute to Arbitration, and they agree to Arbitrate.

APPLICATION FORM FOR FAMILY LAW ARBITRATION

The Applicant hereby requests the FDR Centre to appoint an Arbitrator and to manage and administer the procedures in relation to that Arbitration.

All questions marked with an * are compulsory and you must enter something in the field or the form won't submit - if you have any problems completing the form please contact us on (09) 486 7146 / 0508 FDR CENTRE.

***Please ensure that you complete this application carefully and that all details provided are correct***

Claimant Details

Name *

Address for Service of Notices and documents in relation to the Arbitration *

Email *

Phone *

Mobile

Representative Name

Representative Email

Representative Phone

Representative Company/Firm Name

Respondent

Name *

Address for Service of Notices and documents in relation to the Arbitration *

Email *

Phone *

Mobile

Representative Name

Representative Email

Representative Phone

Representative Company/Firm Name

Second Respondent

Name

Address for Service of Notices and documents in relation to the Arbitration

Phone

Mobile

Representative Name

Representative Email

Representative Phone

Representative Company/Firm Name

Four or more Respondents to this dispute

If you have more than two respondents to this dispute please type their; Name, Address for Service of Notices and documents in relation to the Arbitration, Email, Phone and Representatives' details here.

Description of Dispute

Please briefly describe the nature of your dispute *

The Relief or Remedy that is sought

Please describe the result you seek *

Agreement to Arbitrate

A copy of the parties’ agreement to refer the dispute to Arbitration by an Arbitrator appointed by the FDR Centre is attached? *

Yes

Upload your Agreement here

Special Requests/Requirements of Arbitrator

Please state any preferred expertise / knowledge / professional background (if any) of the person to be appointed as Arbitrator

Are the parties in agreement as to the preferred expertise?

Yes

Upload a copy of the document recording the parties’ agreement as to the Arbitrator’s expertise

Panel of Arbitrators

Please advise whether the parties have reached agreement as to any person (or persons) on our Panel of Arbitrators whom they wish to request the FDR Centre to appoint as Arbitrator in this matter

(please note that we will have regard to any such agreement but will not be bound by it, and any appointment will be at the sole discretion of the Registrar)

Please list here the person (or persons) you wish to request (if any)

Are the parties in agreement as to whom they wish to act as Arbitrator in this matter?

Yes

Upload a copy of the document recording the parties’ agreement as to the Arbitrator here

Inspection of the Subject Matter of the Dispute

Please advise whether the parties are likely to request the Arbitrator to carry out an inspection of the subject matter of the dispute or any other thing to which the dispute relates

(Please note that any inspection will be carried out at the sole discretion of the Arbitrator)

Is it likely that an inspection will be required? *

Yes

If an inspection is likely please give details here

Agreement

I confirm that the information I have supplied is true and correct to the best of my knowledge and that I have read and accepted the terms and conditions of the New Zealand Family Dispute Resolution Centre Ltd *

I confirm

Security Amount

Payment can be made online by direct credit/internet banking (please note: some banks may require special approval from you to authorise payments larger than a certain amount per payment or per day, if in doubt please phone your bank)

Please make payments to: Westpac Bank Account Number: 03 0252 0839830 02 for NEW ZEALAND DISPUTE RESOLUTION CENTRE. Please use your full name as the payer reference

An email will be sent to you after submitting this form which includes our bank account details for your records so that you can make payment. (Please note: payment is required before an arbitrator will be appointed)

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APPLY FOR FAMILY LAW ARBITRATION

APPLICATION FORM FOR FAMILY LAW ARBITRATION