Forms for mediation
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The following forms relate to farmer and creditor-initiated mediation under the Farm Debt Mediation Act 2011.
Forms relating to creditor-initiated mediation
Form 1: Notice of availability of mediation (section 8 notice from the creditor to the farmer)
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.
Form 2: Farmer accepts creditor offer of mediation (section 9 notice from the farmer to the creditor)
Form 3: Notice to the VSBC that creditor-initiated mediation is required (can be completed online or downloaded to complete in Word)
N.B. along with form 3, the creditor also sends the VSBC copies of forms 1 and 2.
Form 6: Notice of decision not to mediate (section 19(1)(b) notice from the farmer to the creditor)
Forms relating to farmer-initiated mediation
Form 7: Farmer request for farmer-initiated mediation concerning farm debt (section 9(1)(b) notice from the farmer to the creditor)
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.
Form 8: Creditor agrees or refuses to enter into farmer-initiated mediation (section 10(1) notice from the creditor to the farmer)
Form 9: Notice to the VSBC that farmer-initiated mediation is required (can be completed online or downloaded to complete in Word)
N.B. along with form 9, the creditor also sends the VSBC copies of forms 7 and 8.
Farmer request for a prohibition certificate
Form 10: Farmer request for prohibition certificate (can be completed online or downloaded to complete in Word) – learn more about prohibition certificates
Creditor request for an exemption certificate
Form 4: Creditor request for exemption certificate (can be completed online or downloaded to complete in Word) – learn more about exemption certificates
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.
For general information about the forms or queries about farm debt mediation, contact us by calling 1800 878 964 or emailing email@example.com.
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.