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Application for Mediation

Use this form to:

  • Lodge a retail tenancy dispute notice under the Retail Shop Leases Act 1994 (section 55(a)).

OR

  • Apply for mediation of a small business dispute under section 21 of the Queensland Small Business Commissioner Act 2022.

Before you start, please have your

  • lease document

  • Contact details for the respondent

A link to make a payment of an equal share of the fee ($185.50 each, for two party disputes) will be sent to both parties when your matter progresses.

Please note, the QSBC cannot mediate a dispute about a matter that is currently before or has been decided by arbitration or a court.


Applicant details

Please enter details as per the lease or agreement.

Select...

Lease details

This should be the legal entity that is a party to the lease, as per the lease, which might look like - 'XYZ PTY LTD', 'Corp LTD', 'XYZ PTY LTD as trustee for ...'
This should be the legal entity that is a party to the lease, as per the lease, which might look like - 'XYZ PTY LTD', 'Corp LTD', 'XYZ PTY LTD as trustee for ...'
e.g. Maroon Tower, Shop 3, Level 2, 123 Alpha Street, Cairns, Qld.
Select...

Dispute details

Please summarise the issue here in 4-7 words.
If you do not have an estimate of the value, leave blank. If you have an estimate, you should enter a number rounded to the nearest hundred. Do not include an amount for interest and costs. This field is to help us understand a rough estimate of the claim value, and where it might go for determination if it cannot be resolved through negotiation or mediation.

Declarations

  • The applicant is a party to the dispute about which this application for mediation is being made.

  • The application for mediation is not frivolous or vexatious and is given in good faith.

  • The applicant consents to the QSBC sharing this application for mediation, and any other relevant information or documents, with the other party to the matter, and if assigned, a QSBC mediator, and if referred, to QCAT.

  • The information provided by the applicant in this application for mediation is true and correct to the best of the applicant's knowledge and belief.


Privacy statement

By lodging an application for mediation, you consent to:

  • The QSBC sharing the application for mediation and any other relevant information or documents with the other party

  • The QSBC sharing the application for mediation and any other relevant information or documents with a QSBC Mediator and/or the Queensland Civil and Administrative Tribunal (QCAT).

By submitting this form, you consent to the Queensland Small Business Commissioner (QSBC), collecting, sharing, disclosing and using your personal and other information (such as name, email address, telephone number, leasing information and dispute details) provided in this form to administer mediation services and provide dispute resolution services. You consent to your personal and other information being shared with other Queensland Government departments or agencies including agencies providing services for Queensland Government departments, to provide information and services to you.

The QSBC may also use deidentified personal information for reporting, research and statistical purposes. Personal information will be handled in accordance with the Information Privacy Act 2009 and will not otherwise be used or disclosed unless authorised or required by law.