Apply for Family Law Mediation

Send by email

Before submitting your application form please ensure:

1. You have read and understood the Family Law Mediation Rules and Protocols.

2. The other party is aware that you wish to submit your dispute to Mediation.  

If you don't already have a written agreement you can use the Mediation Agreement and Schedule of Matters in Dispute located under the Agreements heading.

APPLICATION FORM FOR FAMILY LAW MEDIATION

The Applicant hereby requests the FDR Centre to appoint a Family Law Mediator and to manage and administer the procedures in relation to that Mediation.
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***
First Party
Please type First Party Contact Person/Representative Phone number and cell phone number (if available)
Second Party
Third Party
Four or more Parties to this dispute
Description of Dispute
Agreement to Mediate
Special Requests/Requirements of Mediator
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)
Agreement
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 a mediator will be appointed)