Mediation Request Form Have all the parties agreed to mediate this matter? YESNO Please Read Parties who wish to apply for mediation under MTI EA Mediation Centre Rules must complete this Request for Mediation form. Please copy all the relevant parties to the dispute when sending the Request for Mediation to MTI East Africa. Fee Please note that the non-refundable filing fee of Kshs 50,000 (inclusive of VAT) per party will be payable within three (3)working days after MTI East Africa acknowledges the receipt of this Request. MTI EA will process this request upon full payment of the filing fee Details of Parties Note; Where there are more than 2 parties, please provide the details for them in a separate Attachment Applicants Applicants Particulars Applicants Contact Particulars Your email Contact Number Address Address Respondents Respondents Particulars Respondent Contact Particulars Your email Contact Number Address Details of Dispute Quantum of Claim (Ksh) Quantum of Counter Claim (Ksh) Others Type of Dispute AgencyBanking/Financial InstrumentsCompany/ ShareholdersInformation TechnologyConstruction/Contractors DefamationEmploymentFamily/NeighborInsuranceProperty/Trademarks/CopyrightJoint Venture/PartnershipPersonal InjuryProfessional MalpracticeRenovationSale & Purchase of PropertySale/Supply of Goods &Services/TitIe of GoodsSportsShippingTenancyTortsTrustOthers Available Dates for Mediation Please provide a few available dates - if possible, mutually agreed dates Date Option 1 Date Option 2 Mediator Preferences (Please note that when parties choose their own mediator, the selected Mediator(s) is/are entitled to charge his/her commercial rates. MTI E.A 's published Fee Schedule will not be applicable) Mediators Preference Selection Parties Wish to Choose Their Own MediatorsParties wish for MTI EA to appoint appropriate mediators Mediator Background / Attributes Signature Applicates Name (Full names) Application Date Please leave this field empty.
