Here you can download the delaration of independence for mediators

THE CEPANI SECRETARIAT
RUE DES SOLS, 8
B-1000 BRUSSELS
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Case No.

DECLARATION OF INDEPENDENCE BY THE MEDIATOR(*)

I the undersigned,

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

? 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 Rules.

? declare that I am fully independent of:

? the parties
? their legal counsel

? 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).



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

Signature:

Name:

* Tick the corresponding boxes.