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:
3. 申請調解人聯繫電話Telephone:*
4. 申請調解人郵箱E-mail:*
5. 申請人郵寄地址Adress:
6. 被申請調解人Party B:*
7. 被申請人委託代理人Entrusted Agent:
8. 被申請調解人聯繫方式 Telephone:*
9. 被申請調解人郵箱 E-mail:
10. 調解語言 Language of Mediation*
普通話Mandarin
英語English
粵語Cantonese
其他Other
11. 爭議標的額 Total value involved in the case:*
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 )
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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