Family Dispute Resolution Mediation Form Name(Required) First Last Address Street Address Suburb State Post Code Home Telephone NumberWork Telephone NumberMobile Telephone NumberEmail(Required)Have you seen a Lawyer about this matter?Lawyers Telephone NumberLawyers Email AddressWill your Lawyer be attending mediation? Yes No Name/s of children & Date of Births:Name of other party:(Required)Address of other party Street Address Suburb State Post Code Telephone numbers of other partyEmail address of other partySolicitor actingSolicitor acting emailSolicitor acting phoneMatter relates to: Property Parenting (601) Is there any problem attending at same time as the other party: Yes No Do you require separate rooms: Yes No Nature of dispute (explain briefly what you would like to discuss at the mediation):If a property matter, is solicitor attending mediation? Yes No Are there any court proceedings on foot? Yes No If yes please provide date of when matter next in court.Any current AVOs? Yes No (If yes please provide a copy of the AVO)Max. file size: 100 MB.Are there any current orders? Yes No (If yes please provide a copy)Max. file size: 100 MB.If a children’s matter has a notice of child abuse or family violence been filed in this matter? Yes No If this is a property mediation please list all the assets including superannuation and liabilities that you wish to discussCompleted by