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HomeDECLARATION 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.