Get Adobe Flash player
欢迎访问中国国际贸易促进委员会重庆市委员会网站!
 
法律服务
热点信息
友情链接
目前所在位置:首页 > 法律服务 > 商事调解 > 正文

调解申请表

发布人:调解中心 发布日期:2014/7/17 来源:本站 浏览:次 字号:

 
调解申请表

Mediation Application Form

 

I. 争议方Parties in the Dispute 

 

 

申请人Applicant

公司名称Company Name:

 

法人代表Company Representation:

                             电话Telephone:

联系人Contact Person:

 

联系地址Address:

 

 

邮编Postal Code:

 

城市,国家City, Country:

 

电话Telephone:          

 

传真Fax:

 

电子邮件E-Mail:

 

代理人Representation

                             电话Telephone

联系地址Address

                             传真Fax

电子邮件E-Mail

                             

 

 

 

被申请人Respondent

公司名称Company Name  :

 

法人代表Company Representation:

                            电话Telephone:

联系人Contact Person:

 

联系地址Address:

 

 

邮编Postal Code:

 

城市,国家City, Country

 

电话Telephone:          

 

传真Fax:

 

电子邮件E-Mail:

 

代理人Representation

                             电话Telephone

联系地址Address

                             传真Fax

电子邮件E-Mail

                             

 

 

 

II.争议内容Nature of the Dispute  

基本事实The basic facts

争议要点Controversial points

调解请求Mediation request

  

 

争议双方在将争议提交调解时,须随此申请表格附送陈述材料(各一式四份)用以说明基本事实、争议要点和调解请求。双方还应尽可能提交赔偿说明或可能解决争议的方案。

The parties shall attach a descriptionin quadruplicate.of the nature, circumstances and matters of the dispute giving rise to the claims and which are being submitted for mediation.  If possible, both parties should also submit statements of remedies or possible solutions sought. 

 

III.  规则和程序Rules and Procedures  

 

争议双方同意遵守现行有效的中国国际贸易促进委员会调解中心调解规则。 调解须由调解中心按其规定执行。

如果争议双方同意修改该规则, 修改的规则须包括在申请表中。

The parties agree to be bound by the Rules and Procedures of Mediation Center of China Council for the Promotion of International Trade, as amended from time to time. The Mediation shall be administered by the Mediation Center pursuant to its Rules

If the parties agree to modify the Rules, the modifications shall be included with the application form.

 

 

IV. 争议金额Value of the Claim

 

 预计争议金额

Estimated value of the claim:

 

 

V.  免于责任和补偿Hold Harmless and Indemnity

 

争议各方同意,如果调解员因忠实履行职责而导致任何一方当事人可能承担一定的损失、费用或损害,则各方保证该调解员不会因此受到任何损害。

争议双方同意补偿调解员在忠实履行职责时所承担的任何损失、费用或损害。

The parties agree to hold the mediator(s) harmless for any loss, costs or damage that may result to either parties from the mediator's good faith performance of their duties.  They parties agree to indemnify the mediators for any loss, costs, or damage they may bear as a result of carrying out in good faith, their duties as mediators.

 

 

将此表填完后, 请邮寄或传真至RETURN COMPLETED FORM BY FAX OR MAIL TO:

中国贸促会/中国国际商会重庆调解中心

CCPIT/CCOIC Chongqing Mediation Center

  联系方式 Contact Information

 

重庆市江北区杨河一村78号国际商会大厦19  邮编:400020

78 Yanghe Yilu, Jiangbei District, Chongqing 400020,China

电话Tel: (86-23) 67755808,67079282

传真Fax: (86-23) 82217099

电子邮件E-mail: cqmctiaojie@163.com

 

网址Website: http://www.ccpitcq.org/html/flfw/sstj/

 

 

申请人Applicant                                              被申请人Respondent

    

 签字Sign                                                   签字Sign

 

 盖章Seal                                                   盖章Seal

                                                    

 日期Date                                                               日期Date

中国国际贸易促进委员会重庆市委员会 版权所有 地址:重庆市江北区杨河一村78号国际商会大厦19楼 电话:(023)67870371 (023)67870375 
  (浏览本网站,建议将分辨率设置为1024*768) ICP备案:渝ICP备12002785号     技术支持:讯迈科技

渝公网安备 50010502000519号