Mediation Application Form
T.C.
…… Mediation Office
MEDIATION APPLICATION FORM
APPLICATION NUMBER: …./….
APPLICATION DATE: …/…/…
APPLICANT INFORMATION
TR Identity No:
Name Surname:
Profession:
Education Status:
Address:
Acting
COUNTERPARTY INFORMATION
TR Identity No
Name Surname
Profession:
Education Status:
Address:
Deputy
APPLICATION INFORMATION
Type of Case:
Does the Opposing Party Have Information :
Application Subject Application Status:
Declarations Regarding the Subject of Application:
I hereby declare that I am aware that the mediator will be selected by the parties unless another procedure is agreed upon, that I have read and understood all the explanations in the application petition, that I have submitted all the information I have regarding the subject of the application in full, and I hereby request and demand that this application be processed.
Applicant
Signature