Mediation by Agreement – Dignified Dispute Resolution

Have all the parties agreed to mediate? If so, continue to complete this form. Only fields marked with * are required. Your information is protected by our privacy policy.

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01. Your Contact Info

Name

If you are acting for a business, the registered name of the business:

Phone number

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02. Do you, or the other party, have an attorney?

Your Attorneys Name

The other parties Attorney Name

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03. The dispute or issue!

Dispute Information: What type of dispute do you have?

Dispute Information: Please provide a brief description of nature of dispute

Would you prefer Virtual or In-Person Mediation

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04. Location of the parties

Are both parties in same geographical location?

Which Province within South Africa

Which town in South Africa?

Location of Party 1, if outside South Africa

Location of Party 2, if outside South Africa

Consent to submit this information

Yes, I consent to sharing this information with Dignified Dispute Resolution.
We will make use of this information to contact you. All information you provide is protected by our privacy policy.

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