星辰前海律師調解申請表

請確保所提交的信息真實有效。
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1.
申請調解人Party A:
2.
委託代理人Entrusted Agent:
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3.
申請調解人聯繫電話Telephone:
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4.
申請調解人郵箱E-mail:
5.
申請人郵寄地址Adress:
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6.
被申請調解人Party B:
7.
被申請人委託代理人Entrusted Agent:
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8.
被申請調解人聯繫方式 Telephone:
9.
被申請調解人郵箱 E-mail:
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10.
調解語言 Language of Mediation
普通話Mandarin
英語English
粵語Cantonese
其他Other
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11.
爭議標的額 Total value involved in the case:
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12.
爭議事項 Statement of case:
13.
申請指定調解員 Selection of Designation of the Mediator (詳見調解員名冊 See The Panel of Lawyer Mediators )
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14.
我已閱讀《廣東星辰(前海)律師事務所律師調解中心調解規則》,并自願進行調解。I have read The Sincere Qianhai Lawyer Mediation Center Mediation Rules and agree to the terms of Rules.
是YES
否NO
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