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Request for Mediation

Section 1 - Details of the Parties

Details of the First Party
ID Type
One file only.
32 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, odf, pdf, doc, docx, ppt, pptx.
Details of the Second Party
ID Type
One file only.
32 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, odf, pdf, doc, docx, ppt, pptx.
For additional parties

Section 2 - Brief details of the Claim

If the matter is currently before the Qatar International Court or QFC Regulatory Tribunal and has been stayed to allow for mediation, please provide the following details:

Section 3 – Agreement to Mediate

Have all Parties agreed to mediate this matter?
If ‘Yes’, please provide evidence (e.g. a copy of the mediation agreement) along with this completed form.  If ‘No’ and you are asking the Registry to approach the other party/parties to see if they are prepared to agree to mediate, please provide any relevant information below.
Unlimited number of files can be uploaded to this field.
32 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Section 4 - Mediation Session

Do the parties agree to the QICDRC fixing the date for the mediation
Are the parties’ content for the mediation to take place virtually?

Section 5 - Background of the Dispute

Nature of the Dispute
Details of the Dispute
Unlimited number of files can be uploaded to this field.
32 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Section 6 - Preferred Language

Preferred Language

Section 7 - Additional Information

Please provide any other information which you consider would be of assistance

Unlimited number of files can be uploaded to this field.
32 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Section 8 - Signatures

By signing the below, the parties acknowledge that they are making a formal request for mediation to be conducted in accordance with the QICDRC Mediation Rules.

First Party
Sign above
Second Party
Sign above

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