…… Mediation Office

MEDIATION APPLICATION FORM

APPLICATION NUMBER: …./….

DATE OF APPLICATION: …/…/…

APPLICANT INFORMATION

TC ID No:

name surname:

Job:

Education Status:

Address:

Attorney:

COUNTERPARTY INFORMATION

TC ID No

name surname:

Job:

Education Status:

Address:

Attorney:

APPLICATION INFORMATION

Type of Case:

Does the Counterparty Have Information :

The Subject Application Status:

Statements about the Subject of the Application:

I declare that I know that the mediator will be chosen by the parties unless another procedure is agreed, that I have read and understood all the explanations contained in the application petition, that I have submitted all the information I have about the application in full, and that I submit and request that this application be processed.

The Applicant

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