Mediation Intake Form Template for Philippines

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Key Requirements PROMPT example:

Mediation Intake Form

"I need a Mediation Intake Form for a commercial dispute between my manufacturing company and a supplier in Manila, to be filed with the Philippine Mediation Center by March 2025, with provisions for multiple sessions and language translation requirements."

Document background

The Mediation Intake Form is a crucial document used in the Philippine alternative dispute resolution system, designed to initiate the mediation process efficiently and effectively. It serves as the first formal step in establishing a mediation procedure, whether through private mediation centers or court-annexed programs. The form is structured to comply with Republic Act No. 9285 (Alternative Dispute Resolution Act of 2004) and related Philippine regulations, including data privacy requirements under RA 10173. It captures essential information about the disputing parties, the nature of their conflict, previous resolution attempts, and logistical preferences for the mediation process. This document is particularly important for ensuring that mediators and mediation centers have all necessary information to assess the suitability of the case for mediation and to make appropriate arrangements for the proceedings.

Suggested Sections

1. Personal Information: Basic contact details of the party filling the form, including name, address, contact numbers, email, and preferred method of communication

2. Other Party Information: Contact information for the other party/parties involved in the dispute

3. Dispute Overview: Brief description of the nature of the dispute, including key issues and any pending court cases

4. Previous Resolution Attempts: Information about any previous attempts to resolve the dispute, including negotiations or other ADR processes

5. Legal Representation: Details of any legal representatives or advisors involved

6. Preferred Mediation Arrangements: Preferences for mediation timing, venue, language requirements, and any special accommodations needed

7. Confidentiality Acknowledgment: Statement acknowledging the confidential nature of the mediation process as per RA 9285

8. Certification and Signature: Declaration of truth of information provided and signature section

Optional Sections

1. Court Case Information: Details of any related court cases if the mediation is court-annexed

2. Additional Participants: Information about other participants who may need to be present (experts, interpreters, support persons)

3. Special Circumstances: Any special circumstances that might affect the mediation process (safety concerns, power imbalances, etc.)

4. Financial Information: Basic financial information if relevant to the dispute

5. Settlement Authority: Confirmation of authority to settle if representing an organization

Suggested Schedules

1. Schedule A - Supporting Documentation Checklist: List of documents that should be attached to the intake form

2. Schedule B - Fee Schedule: Information about mediation fees and payment arrangements

3. Schedule C - Additional Party Information: Form for providing information about additional parties if more than two parties are involved

4. Appendix 1 - Mediation Rules and Procedures: Summary of applicable mediation rules and procedures

5. Appendix 2 - Consent Forms: Additional consent forms required for specific circumstances

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Legal Services

Financial Services

Real Estate

Construction

Manufacturing

Retail

Healthcare

Education

Technology

Professional Services

Government and Public Sector

Non-profit Organizations

Insurance

Transportation and Logistics

Energy and Utilities

Relevant Teams

Legal

Compliance

Risk Management

Human Resources

Corporate Governance

Administrative Services

Customer Relations

Claims Processing

Dispute Resolution

Corporate Communications

Relevant Roles

Legal Counsel

Mediator

Alternative Dispute Resolution Specialist

Compliance Officer

Risk Manager

Human Resources Manager

Corporate Secretary

Legal Operations Manager

Court Administrator

Case Manager

Dispute Resolution Coordinator

Legal Administrative Assistant

Corporate Governance Officer

Claims Manager

Customer Relations Manager

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