The Applicant hereby requests the New Zealand Dispute Resolution Centre Ltd (NZDRC) to appoint an Evaluator for the purpose of an Early Neutral Evaluation and to manage and administer the procedures in relation to that Early Neutral Evaluation.

***Please ensure that you complete this application carefully and that all details provided are correct***

1. First Party’s Details
2. Second Party’s Details
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2a. Third Party’s Details
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2b. Fourth Party’s Details
3. Applicant’s Details (Please complete only if different from First Party’s details)
4. Brief Description of the Nature of the Dispute
5. The Relief, Remedy, or Outcome that is sought
6. Agreement to Early Neutral Evaluation
Yes No
7. Special Requests/Requirements of Early Neutral Evaluator
Yes No
8. Panel of Evaluators
Yes No
9. Security Amount
Amount in Dispute: NZ$ 
Security Amount: NZ$ 
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10. Agreement
I confirm that the information I have supplied is true and correct to the best of my knowledge and that I have read and accepted the terms and conditions of the New Zealand Dispute Resolution Centre Ltd