Fillable Case Submission Form Resolving Disputes Worldwide INSTRUCTIONS (JAMS)

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Case Submission Form Resolving Disputes Worldwide INSTRUCTIONS (JAMS)

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RESPONDENT
CLAIMANT
REPRESENTATIVE/ATTORNEY
NAME
COURT FILE NUMBER
(IF ANY)
EMAILFAXPHONE
ZIPSTATE
CITY
ADDRESS
FIRM/
COMPANY
Resolving Disputes Worldwide
Case Submission Form
INSTRUCTIONS
Please submit this form to your local JAMS Resolution Center along with a caption page,
if available. Additionally, if multiple parties are involved, attach a service list. A JAMS
professional will contact all parties to coordinate the ADR process. To file an Arbitration,
please use the Demand for Arbitration form which can be found at www.jamsadr.com.
CASE CAPTION
VS.
Page 1 of 4JAMS Case Submission Form
WEBSITE ADDRESS
REPRESENTATIVE/ATTORNEY
NAME
EMAILFAXPHONE
ZIP
STATECITY
ADDRESS
FIRM/
COMPANY
WEBSITE ADDRESS
NOT ARBITRATION
COURT FILE NUMBER
(IF ANY)
www.jamsadr.com
1-800-352-JAMS
INSURANCE INFORMATION
CARRIER
NAME
FILE/CLAIM
NUMBER
EMAIL
FAX
PHONE
ZIPSTATECITY
ADDRESS
CLAIM
REPRESENTATIVE
OTHER PARTIES TO DISPUTE
LIST PARTIES WHO HAVE AGREED TO USE ADR
Case Submission Form (continued)
Page 2 of 4JAMS Case Submission Form
Resolving Disputes Worldwide
NATURE OF DISPUTE / CLAIMS & RELIEF SOUGHT BY CLAIMANT
ATTACH A BRIEF DESCRIPTION OF THE CASE, INCLUDING ISSUES IN CONTROVERSY AND CASE HISTORY.
Case Submission Form (continued)
Page 3 of 4JAMS Case Submission Form
Resolving Disputes Worldwide
CASE INFORMATION
REQUESTED RESOLUTION CENTER
SESSION INFORMATION
MEDIATION NEUTRAL ANALYSIS
REFEREE OR
SPECIAL MASTER
TEMPORARY JUDGE OR
JUDGE PRO TEM
OTHER
IF “OTHER” INCLUDE
DETAILS
REQUESTED RESOLUTION CENTER
REQUESTED RESOLUTION CENTER
REQUESTED SESSION DATES
REQUESTED RESOLUTION CENTER
ESTIMATED SESSION DURATION
FEE SPLIT
PLAINTIFF/CLAIMANT
NEUTRAL INFORMATION
PARTIES MUTUALLY AGREE ON NEUTRAL(S)?
%
DEFENDANT/RESPONDENT
%
SUBMISSION INFORMATION
SUBMITTED BY DATE
PLAINTIFF ATTORNEY DEFENSE ATTORNEY CLAIM REPRESENTATIVE OTHER PARTY
IF “OTHER” INCLUDE DETAILS
FIRM/
COMPANY
EMAIL
FAXPHONE
NEUTRAL NAME(S) (IF APPLICABLE)
Case Submission Form (continued)
Page 4 of 4JAMS Case Submission Form
SUIT FILED?
MEDIATION DEADLINE (IF APPLICABLE)
CASE NUMBER
TRIAL DATE
Resolving Disputes Worldwide
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Case Submission Form Resolving Disputes Worldwide INSTRUCTIONS (JAMS)

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Completed 17 July 2021

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