Mediation application form

Please fill in the required information in the input form below and click the "Confirm Input" button.

Be sure to fill in the required items!


1.Contact Details of Applicant and Applicant’s Counsel

(1) Applicant's Information
Name of Individual or Company *
Authorized Representative (for Companies)
Telephone Number
Email Address *
(2) Information of Applicant’s Counsel
Name of Law Firms Representing
Name of all Counsels Representing
Counsel's Contact Information in Charge of Contact
Information of the petitioner *

2.Contact Details of Respondent and Respondent’s Counsel

(1)Respondent's Information
Name of Individual or Company *
Authorized Representative (for Companies)
Telephone Number
Email Address *
(2) Information of the Respondent's Counsels
Name of Law Firms
Name of All Counsels Representing
Contact Information of Counsel in Charge
If the number of party is two or more, please add information regarding the additional contact details of such parties and their counsels in the column 2’ or 3’.

3.Amount of Dispute

Amount of Dispute (with Currency)

4.Type of Dispute and Brief Details of Case

Area of dispute
Brief Details of Case *

5.Agreement to Mediation

Please check *
Do you want to use JIMC-SIMC Joint Covid-19 Protocol? *

6.Mediator

Do you need recommendation or appointment of Mediator(s)? *
Special requirement for a mediator (mediators).

7.Language for Mediation

Language *
Other requests.

After entering the required items, press the confirmation button.