NUJS

Dear Mediation Enthusiast,

Hope you doing good and tirelessly working towards spreading the culture of
mediation in India and world over. We are glad to inform you that Indian Institute of
Corporate Affairs (IICA) has carried out six mediation trainings across India in a
period of one year having trained more than one forty individuals. IICA is constantly
trying to inculcate the practice of mediation as a dispute resolution mechanism in the
sphere of commercial and civil disputes. Recognizing our efforts in this sphere,
National University of Juridical Sciences (NUJS), Kolkata has assigned us with the
responsibility of nominating an independent Jury for recognizing the contributions of
top ten individuals in the field of mediation in India.

Owning to the same, kindly fill in the form below and send it to us at
mediation.iica@gmail.com to be sent across to our esteemed jury for impartial
screening and selection. You can also download the form from www.mediationiica.in.
The top ten individuals will be felicitated by NUJS, as part of the Indian Mediation
Week project.

NOTE: Last date for sending in your nominations is 30th September, 2017.

Kindly fill in the details in capital letters and mention all dates in date/month/year format.
PERSONAL DETAILS
Name Mr./ Miss/Mrs.

Date of birth: ___/___/______ Place of birth:_____________________

CONTACT DETAILS
Address:

City: State:
Country: Zip Code
Email: Phone:
Are you presently involved in any legal proceedings in a court of law in India
Yes No

If yes, please provide details:

 NUJS

Educational Background

MEDIATION TRAINING (s) Obtained

NAME OF INSTITUTION/ ORGANIZATION WITH PLACE

SL. YEAR
OF TRAINING
NO.

MEDIATION PUBLICATIONS
 NUJS

PROFESSIONAL EXPERIENCE

Your Contributions to the field of Mediation in India (workshops conducted, trainings

conducted, awareness programs conducted etc.)
 NUJS

BRIEFLY OUTLINE YOUR FUTURE HOPES AND ASPIRATIONS FOR

MEDIATION IN INDIA

DECLARATION
I hereby declare that the information provided by me in this application is true and correct to the
best of my knowledge and that I have made no intentional attempt of material concealment.

PLACE:
DATE: SIGNATURE OF APPLICANT