ADR Consent & Submission Form — Entity Portal

PART A — DISPUTE & PARTIES IDENTIFICATION

Complaint Docket Reference Number*

Submitting Party Capacity*

Complainant

Respondent

Joint Submission by Both Parties

Full Legal Name of Submitting Party / Signatory*

Organization / Entity Name (if applicable)

Official Communication Email*

Direct Contact Phone*

PART B — FORMAL CONSENT TO ADR (SECTION 60)

Consent to Engage in Alternative Dispute Resolution*

Consent Granted — We agree to resolve this dispute through ADR pursuant to Section 60

Consent Declined — We prefer formal determination under Section 58

Preferred ADR Mechanism*

PART C — PROPOSED SETTLEMENT TERMS & NEGOTIATORS

Outline of Proposed Settlement Terms*

Designated Settlement Representative (Full Name & Title)*

Representative Contact Info*

PART D — CONFIDENTIALITY & GOOD FAITH UNDERTAKING

Statutory Confidentiality Undertaking*

I acknowledge that all communications, offers, and documents exchanged during the ADR proceedings are without prejudice and confidential pursuant to Section 60.

Good Faith Participation Commitment*

I undertake to engage constructively, cooperatively, and in good faith to reach an amicable settlement.

Authorized Signatory Full Name*

Date of Execution*

Alternative Dispute Resolution (ADR) Consent & Submission

PART A — DISPUTE & PARTIES IDENTIFICATION

PART B — FORMAL CONSENT TO ADR (SECTION 60)

PART C — PROPOSED SETTLEMENT TERMS & NEGOTIATORS

PART D — CONFIDENTIALITY & GOOD FAITH UNDERTAKING