…… Mediation Office
MEDIATION APPLICATION FORM
APPLICATION NUMBER: …./….
DATE OF APPLICATION: …/…/…
APPLICANT INFORMATION
TC ID No:
name surname:
Job:
Education Status:
Address:
Attorney:
COUNTERPARTY INFORMATION
TC ID No
name surname:
Job:
Education Status:
Address:
Attorney:
APPLICATION INFORMATION
Type of Case:
Does the Counterparty Have Information :
The Subject Application Status:
Statements about the Subject of the Application:
I declare that I know that the mediator will be chosen by the parties unless another procedure is agreed, that I have read and understood all the explanations contained in the application petition, that I have submitted all the information I have about the application in full, and that I submit and request that this application be processed.
The Applicant
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