Small Claims - Respondent Response Form

Independent Conciliation Service for County Court Small Claims Track Disputes

Respondent Response Form

Small Claims Conciliation Scheme

(Claims up to £10,000)
The conciliation process will focus on what you and your customer want and will try to find a way of solving the problem that you are both happy with.

CEDR is not responsible for paying compensation or making a financial award. If the dispute is resolved via the conciliation process and a payment has been agreed the parties will make any payment directly.

What happens next?
- Please review the application form and any supporting evidence from the Claimant. Please then complete and return this form within 10 working days.
- Upon receipt CEDR will confirm the identity of the conciliator assigned to this case and they will contact you by email or telephone, usually within 5 working days. A copy of your response form will be sent to the Claimant for their reference only.
- The conciliator will endeavour to conclude the conciliation within 30 working days of their appointment.
- Full details of the conciliation procedure and some information on the process can be found in the Service Rules available on the CEDR website.
- If you have any questions, please contact CEDR via email at: applications@cedr.com
1. Your details (Respondent)

Please give the full trading name and details of your company:
Application Reference Number from party A*
Company Name*
Contact name*

First NameLast Name
Email*
example@example.com
Telephone

Area CodePhone Number
Address

Street Address

Street Address Line 2

TownCounty

Postcode

2. Action/s taken
Please briefly provide a summary of the dispute and describe the action/s you have taken to resolve the matter.
3. Desired outcome
Please detail the outcome you are seeking from the conciliation process.
4. Declaration
Please read the following statements carefully and make sure that you understand your responsibilities before signing this form.

Data Protection Act: The Data Protection Act allows companies to provide information and/or documents about customers to CEDR and the conciliator with your consent. By completing this form you are giving your consent.
- I/We apply for the appointment of a conciliator in accordance with this conciliation agreement to conciliate the dispute between us and the Claimant in accordance with conciliator’s powers set out in the Conciliation Scheme Rules.
- I/We agree and understand that the conciliator’s recommendations are not binding unless written down and signed by both parties in the agreement.
- I/We also understand that conciliation is a confidential process in which the Conciliator as a neutral third party assists parties in working towards a negotiated agreement, with the parties in ultimate control of decision to settle and the terms of resolution.
- I/We declare that I/we am/are authorised to sign this form on behalf of the Business and understand that it is my/our responsibility to ensure that I/we understand the process and will seek guidance from CEDR if required.
- I/We understand that a copy of this Response will be given to the Claimant
- I/We understand that any other information given to the Conciliator during the conciliation will be confidential unless I/We permit the Conciliator to give information to the Claimant
- I/We accept that the proceedings are confidential and without prejudice.
- I/We understand that the Conciliator does not give legal advice.
- I/We also understand the Conciliator does not act as a judge or arbitrator. them, the conciliator may recommend a solution to the dispute.
- I/We understand and agree that CEDR will charge each party a fee of £240.00 (i.e. £200.00 plus VAT) per party to provide the Service.
- I/We believe that the facts stated in this application and claim form are true.
Signature:*

Clear
Type your name*

First NameLast Name
Date*

MonthDayYear
Date

5. Payment

Small Claims Application£200 application fee + VAT

£200.00 Quantity

Subtotal

£0.00

Tax

£0.00

Total

£0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Submit the form
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Independent Conciliation Service for County Court Small Claims Track Disputes

Respondent Response Form

Small Claims Conciliation Scheme

1. Your details (Respondent)

2. Action/s taken

3. Desired outcome

4. Declaration

5. Payment

Submit the form