Mediation Registration Form

To start the mediation, the Technology Arbitration & Mediation Institute (hereinafter ‘TAMI’) needs the following information of both parties. Please fill in the information referred to below.

As soon as the information of both parties is known, TAMI will send the parties a mediation agreement (see attachment). TAMI has a list of registered MfN mediators who specialise in business mediation and have an affinity with technology.

From this list, the parties either choose their mediator or TAMI makes a proposal. After the mediation agreement has been signed by both parties and the mediator, the mediation starts.

a. Information party A:

Name:

Address:

Place of residence:

Telephone number:

E-mail address:

VAT number:

Where relevant, information representative claimant

Name representative :

Address :

Telephone number:

E-mail address:

Place of residence:

b. Information party B

Name:

Address:

Place of residence:

Telephone number :

E-mail address:

VAT number:

Where relevant, information representative defendant

Name representative : :

Address :

Place of residence:

Telephone number:

E-mail address

c. A short description of the dispute

The objective of this description is to inform the TAMI administrator on the nature and scope of the case.

Having a financial interest of

up to €. 1,000,000€ 1,000,000 en hoger

d. Appointment of the mediators
From the list of the mediator candidates prepared by TAMI, the parties either choose their mediator
or TAMI makes a proposal.

When the parties appoint a mediator themselves, please fill in the information below:

Parties jointly appoint:
Name of the mediator:

A mediator should be impartial and independent. He or she may not have close personal or business
relationships with one of the parties. He or she may not have any direct personal or commercial interest in the outcome of the case. At the same time, the mediator may not have expressed his or her
opinion on the case to either party prior to his or her appointment.

The mediator's qualifications:

With regard to the mediator's qualifications:
(a) The parties have agreed that the mediator will need to have the following qualifications:

(b) The parties have not agreed on anything but individually prefer:

f. Place of mediation

The parties determine the place of mediation, failing which TAMI will do so.
With regard to the place of mediation:
(a)The parties have agreed that this will have to be
(b)The parties have not agreed on anything but one party prefers:

g. Language of the mediation

With regard to the language of the mediation:
(a) The parties have agreed that this will have to be
(b) The parties have not agreed on anything but individually prefer language.:

h. Other particulars as regards the mediation procedure

If the parties wish to communicate particular aspects TAMI needs to be aware of in the context of the mediation procedure, the parties may do so here.

I accept the terms and conditions:

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Mediation Registration Form

a. Information party A:

Where relevant, information representative claimant

b. Information party B

Where relevant, information representative defendant

c. A short description of the dispute

When the parties appoint a mediator themselves, please fill in the information below:

The mediator's qualifications:

f. Place of mediation

g. Language of the mediation

h. Other particulars as regards the mediation procedure

Offline registration?

Upload

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