Mediation Application Form

The Dispute

Please indicate the type of dispute
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Amount in Dispute
Please enter the amount in dispute in NZD (inclusive of GST, value added tax, or any other similar tax which might apply). In calculating the amount in dispute, interest will not be taken into account unless the interest claimed by a Party exceeds the aggregate principal amount, in which case enter the value of the interest claim alone.
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Preliminary Payment for Rights and Obligations Disputes
A Preliminary Payment fee is required as security for a Mediation of up to 8.0 hours on any given day. Payment instructions are included at the end of this application form.
$0.00
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Preliminary Payment
A Preliminary Payment fee is required as security for a Mediation of up to 8.0 hours on any given day. Payment instructions are included at the end of this application form.
$0.00
Field is required!
Preliminary Payment
A Preliminary Payment fee is required as security for a Mediation of up to 8.0 hours on any given day. Payment instructions are included at the end of this application form.
$0.00
Field is required!
Preliminary Payment
A Preliminary Payment fee is required as security for a Mediation of up to 8.0 hours on any given day. Payment instructions are included at the end of this application form.
$0.00
Field is required!
Preliminary Payment
A Preliminary Payment fee is required as security for a Mediation of up to 8.0 hours on any given day. Payment instructions are included at the end of this application form.
$0.00
Field is required!
Preliminary Payment
A Preliminary Payment fee is required as security for a Mediation of up to 8.0 hours on any given day. Payment instructions are included at the end of this application form.
$0.00
Field is required!
Please briefly describe the nature of the dispute
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The Parties

How many parties are involved in this mediation? Please note a support person or representative is not a party.
  • - select an option -
  • Two
  • Three
  • Four
  • Five
  • Six or more
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Party A (Applicant)

In which capacity is this Party acting?
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Party A: First Name
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Last Name
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Full Name of Trust
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Full Name of Company or Legal Entity
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Is this Party represented by a lawyer or other professional?
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Representative's First Name
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Representative's Surname
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Contact for this Party - First Name
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Surname
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Email address
Please enter the email address of the person/s who should receive correspondence related to this application for Party A. You can enter additional email addresses separated by a comma.
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Phone Number
Please enter the phone number of the main contact for Party A.
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Address
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City
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The Other Party

In which capacity is this Party acting?
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First Name
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Last Name
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Full Name of Company or Legal Entity
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Full Name of Trust
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Is this Party represented by a lawyer or other advisor?
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Contact for this Party - First Name
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Surname
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Representative's First Name
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Representative's Surname
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Email Address
Please enter the email address of the person/s who should receive correspondence related to this application for this party. You can enter additional email addresses separated by a comma.
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Phone Number
Please enter the phone number or the other Party.
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Address
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City
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Other Party

In which capacity is this Party acting?
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First Name
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Last Name
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Full Name of Company or Legal Entity
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Full Name of Trust
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Is this Party represented by a lawyer or other advisor?
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Contact for this Party - First Name
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Surname
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Representative's First Name
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Representative's Surname
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Email Address
Please enter the email address of the person/s who should receive correspondence related to this application for this party. You can enter additional email addresses separated by a comma.
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Phone Number
Please enter the phone number or the other Party.
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Address
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City
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The Agreement to Mediate

Have the parties agreed to mediate with Building Disputes Tribunal? *
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*IMPORTANT: Before proceeding, the parties will need to agree to mediate with Building Disputes Tribunal. To do so the parties can sign the Mediation Agreement at Appendix 2 to the Mediation Rules of Building Disputes Tribunal. Once you have done so, please return to complete an Application for Mediation.
What form of agreement have you entered into?
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Please upload a copy of the mediation clause in your contract, together with the signature page of that contract
Upload your documents...
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Please upload the agreement signed by the parties to mediate with Building Disputes Tribunal
Upload your documents...
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Please upload the agreement signed by the parties.
Upload your documents...
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Have you served a Notice of Mediation on every other Party to the dispute?
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Before proceeding, you will need to serve a Notice of Mediation on every other Party to the dispute. Once you have done so, please return to complete an Application for Mediation.
Please upload a copy of the Notice of Mediation
Upload your documents...
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The Mediator

Have the Parties agreed on a nominee to act as Mediator?
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Is the Parties' nominee currently on the Panel of Building Disputes Tribunal?
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Mediator's Name
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First Name
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Last name
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Company Name (if Applicable)
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Email Address
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Phone Number
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Address
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City
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Have you made any proposal as to a suitable Mediator?
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Proposal Details
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Have the Parties agreed on a preferred date or range of dates for the Mediation session to be scheduled?
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Venue: Have the Parties agreed on a venue for the Mediation? Please provide any details below.
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Preliminary Payment Required
When you click "Submit", you will be re-directed to the security payment options. If you wish to pay later, just select Direct Debit as your payment method.
$0.00
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Please confirm you agree to abide by the Mediation Rules and terms & conditions of Building Disputes Tribunal.
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