DECLARATION OF INDEPENDENCE

Please download the declaration here

File n°:............


DECLARATION OF ACCEPTANCE , AVAILABILITY AND INDEPENDENCE BY THE MEDIATOR


I the undersigned,

Surname: .......................................................First name: ............................................

1. ACCEPTANCE

O Accept the arbitral mission in accordance with the CEPANI Mediation rules 2013.

2. AVAILABILITY

O Confirm, on the basis of the information presently available to me, that I can devote the time necessary to conduct this mediation diligently, efficiently and in accordance with the time limits in the Rules.

3. INDEPENDENCE

O declare that I am fully independent of:

O the parties
O their legal counsel

O draw CEPANI's attention to the following facts and circumstances that could lead any of the parties to doubt my independence (use a separate sheet if necessary).

* * *

O declare that I shall abide by the "Rules of good conduct for procedures requiring the intervention of CEPANI" enclosed as Annex II to the CEPANI Mediation Rules.


Done at .............................., on ......................................

Signature:

 

Tick the corresponding boxes.

 

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