Application for the appointment of a mediator under the RICS Consumer Mediation Dispute Scheme

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DRS2 CM Application for the appointment of a mediator under the RICS Consumer Mediation Dispute Scheme General Information The RICS Consumer Mediation Scheme (the CMS) is an opportunity for consumers to attempt to resolve their disputes without the time and expense of taking the matter to court. It is designed for consumers who have bought goods or services from a trader and who have tried to resolve the issues with the trader. DRS do not charge an administrative fee for the appointment of a mediator under the scheme. Notes to consider before completing the application: Before completing this form please read the Consumer Mediation Scheme Guidance Document. RICS DRS reserves the right to copy the application and/or any accompanying documentation to the responding party and/or representatives. This is on the basis that your application is accepted. The application form is the contract between the consumer and RICS and we will rely entirely upon the information provided. The information submitted on this application is accepted as being accurate and complete. Neither RICS nor the appointed mediator accepts liability in relation to the appointment. Authority to appoint Have you already contacted the trader and submitted a complaint? Have you exhausted the complaints procedure and still remain dissatisfied with the outcome? Please note: for RICS to proceed with your application you will be required to answer yes to the two questions above.

Information about the dispute RICS will need sufficient information about the dispute so to nominate a suitably qualified mediator. Please provide brief details of the nature of the dispute: Please indicate the approximate sum of money in dispute: How long has the dispute been going on? Have you previously tried to negotiate a settlement of this dispute? If yes, please provide details below: Have litigation or arbitration proceedings commenced in respect of this dispute? If yes, please provide details below: 2

Applicant details (Consumer) If either you or the trader is represented please also provide details of the representatives below. RICS DRS will send correspondence to them. Normally DRS communications are sent by email, unless you specify otherwise. Therefore, it is important you provide email addresses. Trader s details Consumer s representative (if applicable) First name: Designation: Firm name: Address: Last name: RICS membership Number: (if applicable) Town/city: Telephone: Direct line: Post code: Trader s representative (if applicable) First name: Designation: Firm name: Address: Last name: RICS membership Number: (if applicable) Town/city: Telephone: Direct line: Post code: 3

Are there any other parties to this dispute? If yes, please detail the parties below: Party 1 Party 2 Is the trader aware that this application has been made? Please note: RICS will be contacting the trader Professional background of the mediator Please let us know if there are any particular requirements you wish us to consider in nominating the mediator for example: (experience, qualification s, time restrictions). (If there are no requirements please state none): Conflicts of interest RICS will take reasonable steps to ensure that the appointed mediator is free from conflict of interest and totally independent. The mediator is required to disclose any involvement to RICS prior to nomination. RICS will never knowingly nominate a mediator who has a conflict of interest. If in your view there are any individuals who would have a conflict of interest regarding this matter, you should list them in the box below. Please also provide for such person, brief but clear reasons for this statement. 4

Name Firm Reason Please note: while RICS will give careful considerations to any representations the approver will reach his/her own decision as to who is appointed. Application submitted by: Consumers Name: Date: Submitting this application form to DRS confirms that you have read and understand the information contained in this application. Your application is accepted on this basis. Please return the completed application form by email or post to: RICS Dispute Resolution Services, 55 Colmore Row, Birmingham B3 2AA drs@rics.org Tel: +44(0)207 334 3806 Your privacy RICS takes the privacy and security of the personal information you provide very seriously. Your details are held in a secure database with authorised access only. We apply data processing policies in compliance with the Data Protection Act 1998 and the Privacy and Electronic Communications Regulations (EC Directive 2003). RICS will not use the information you provide in this application to contact you with offers of products and services. Nor will RICS share your information with third parties for the purpose of sending you details of offers of products and services. Explanatory notes RICS has a duty to act independently and transparently when appointing a dispute resolver. On receipt of a request, DRS will select a suitability qualified RICS Accredited Mediator who is free from conflicts of interest. It is vital that you complete all sections of the application form; incomplete sections may result in delays and an inappropriate nomination. As a matter of policy RICS may forward the information contained in an application form and supplementary documentation in the case details, to the trader in dispute and/or the representatives. Details of the case will also be sent to prospective mediators to help them decide whether they can or cannot take on the nomination. If the dispute is resolved before the mediator is nominated, you must notify RICS as soon as possible. RICS DRS acts in an administrative capacity and will make an appointment in accordance with your application Your application will be processed on the basis that that appointments are often made on behalf of the President/Chairman of RICS by one of his/her duly appointed agents. RICS DRS will not always seek comments from the parties on disclosures made by potential appointees. In some cases the President/Chairman may decline to appoint someone, even if they are satisfied that he potential dispute resolver has no conflicts of interest. Before an appointment is made RICS DRS will take into account a range of factors including representations made by both parties. 5