_Refer to Mediation – Dairy Code

1Dispute

2Parties

3Contact

4Review

5Payment

Party 1

Party Type
Company's Legal Identity
ABN Number
Primary Contact Name
Primary Email Address
Primary Mobile Number
Primary Business Phone Number
Primary Business Address
Street Address City State Zip Code
Comments 1
All Relevant Documents
Drop files here or

Max. file size: 16 MB.
Include previously uploaded documents here.
Has Party 1 recommended a mediator?
- No
- Yes
Party 1 Recommended Mediator
Mediator Name 1
First Last
Mediator Email 1
Mediator Mobile 1
Recommendation 1
Is Party 1 represented by a lawyer?
- No
- Yes
Party 1 Legal Representative
Legal Firm
Lawyer Name 1
Lawyer Email 1
Lawyer Mobile 1
(for personal contact)
Lawyer Phone 1
(add state code to a local number)
Lawyer Address 1
Street Address City State Zip Code
Party 2

Party Type
Type Status
Company's Legal Identity
ABN Number
Primary Contact Name
Primary Email Address
Primary Mobile Number
(for personal contact)
Primary Business Phone Number
(add state code to a local number)
Primary Business Address
Street Address City State Zip Code
Comments 2
All Relevant Documents
Drop files here or

Max. file size: 16 MB.
Include previously uploaded documents here.
Has Party 2 recommended a mediator?
- No
- Yes
Party 2 Recommended Mediator
Mediator Name 2
First Last
Mediator Email 2
Mediator Mobile 2
Recommendation 2
Is Party 2 represented by a lawyer?
- No
- Yes
Party 2 Legal Representative
Legal Firm 2
Lawyer 2
Lawyer Email 2
Lawyer Mobile 2
Lawyer Phone 2
(add state code to a local number)
Lawyer Address 2
Street Address City State Zip Code
Specify the date for the mediation
The Administrator will appoint a Mediator who is available to conduct the mediation during the period requested and agreed between the parties.
Beginning Date*
Start of period when you are available for mediation.
DD slash MM slash YYYY
End Date*
End of period when you are available for mediation.
DD slash MM slash YYYY
Recommend a Mediator
What is the name of the mediator you wish to recommend?
Mediator Contact Mobile
Primary Contact Email

Your Details
Legal Representative Contact Details
Is the Legal Representative an external law firm, or internal legal counsel?*
Primary Contact Name*
Mediation Location
I request that the mediation be conducted in the following State/Town:*
Other State / Town*
IMPORTANT - PLEASE READ
The Adviser will appoint a mediator in the location that advantages both parties but subject to the stipulation of the franchising agreement, the requirements of the Franchising Code of Conduct and the parties' agreement.
This will normally be in the State or Territory in which the franchised business is based (see clause 21 of the Code). However, if your franchise agreement was entered into before 1 January 2015 and not varied or transferred on or after that date, it may provide for a different location, which may apply, see subclauses 3(4) and (5) of the Code.
If either the Franchisee or Franchisor want a mediator appointed in a particular location then you should immediately make your request known to the Resolver.
Your Documents
UPLOAD FILES HERE. This is you opportunity to send any relevant documents to the Mediator and the other parties in the dispute.
Attach copies of any documents or correspondence that provides a background to the dispute, including photos. When submitted these documents will be emailed to all of the parties copied on this form.
You can attach documents in .JPEG, PDF, XLS(X), or .DOC(X) format. Up to 12 separate documents can be included of up to 128MB size in total.
Drop files here or

Accepted file types: jpg, pdf, png, tiff, doc, docx, xls, xlsx, Max. file size: 16 MB, Max. files: 12.

Mediator Appointment Confirmation Document
Terms & Conditions*
I agree to the Terms and Conditions
I request that the Dairy Dispute Resolver refer a mediator to assist with my dispute.

I understand that the Resolver will arrange with both the Complainant and the Respondent to organise for the referral to a mediator to conduct the mediation.

I understand that if the dispute is not referred to a mediator within 28 days, I will be refunded the administration fee in full.
Name*
First Last
Digital Signature*
Hidden
Date*
DD slash MM slash YYYY

Franchising Dispute Resolver Services*
Administration Fee (includes GST)
Credit Card*
Please check if you have activated a Stripe feed for your form.
After clicking Submit, please be patient while your payment details are verified, your party details are processed, and we email you a summary document and invoice.

Nature of Complaint

Party 1

Party 1 Recommended Mediator

Party 1 Legal Representative

Party 2

Party 2 Recommended Mediator

Party 2 Legal Representative

Specify the date for the mediation

Recommend a Mediator

Your Details

Legal Representative Contact Details

Mediation Location

Your Documents