Forms for mediation
On this page
The following forms relate to farmer and creditor-initiated mediation under the Farm Debt Mediation Act 2011.
Forms relating to creditor-initiated mediation
N.B. along with form 1, the creditor must also send the farmer:
- a copy of forms 2 and 6 to allow the farmer to accept or decline the offer of mediation
- a copy of the Victorian Small Business Commission’s (VSBC) Farm debt mediation fact sheet and Guide to mediation.
N.B. along with form 3, the creditor also sends the VSBC copies of forms 1 and 2.
Forms relating to farmer-initiated mediation
N.B. along with form 7, the farmer also sends the creditor a copy of form 8 to allow the creditor to accept the offer of mediation.
N.B. along with form 9, the creditor also sends the VSBC copies of forms 7 and 8.
Farmer request for a prohibition certificate
Creditor request for an exemption certificate
For all farm debt mediation requests and notices, farmers and creditors must use the forms on this page, which have been approved by the VSBC.
Notifications to the VSBC advising that mediation is required (forms 3 and 9) and requests to the VSBC for exemption and prohibition certificates (forms 4 and 10) can be completed online or completed using the Word versions (available for download above) and sent to:
Postal address: GPO Box 4509, Melbourne VIC 3001
For more information:
- see our farm debt mediation process, FAQs and information on important changes to the Farm Debt Mediation Act 2011
- access support and information for farmers and information for creditors
- contact us.