A Declaration as to compliance with section 14 and secition 15 of the Mediation Act 2017 is required to be lodged with the District Court. A draft is below which can be ammended as appropriate.

Schedule C
O.39,r.6(2)

District Court Area of

District No.

Record number

Between

………….. Claimant

………….. Respondent

STATUTORY DECLARATION AS TO COMPLIANCE WITH SECTION *14 *15 OF THE MEDIATION ACT 2017

I, …….. of ……. , *practising solicitor *practising barrister, aged eighteen years and upwards, do solemnly and sincerely declare that:

1. I act on behalf of …….. of …….. , the *claimant in the above-named proposed proceedings (in this declaration referred to as my “client”).
2. I have advised my client to consider mediation as a means of attempting to resolve the dispute the subject of the proposed proceedings.
3. I have provided my client with information in respect of mediation services, including the names and addresses of persons who provide mediation services.
4. I have provided my client with information about—

(i) the advantages of resolving the dispute otherwise than by way of the pro posed proceedings, and

(ii) the benefits of mediation.

5. I have advised my client that mediation is voluntary and may not be an appro priate means of resolving the dispute where the safety of my client and/or their children is at risk.
6. I have informed my client of the matters referred to in sections 10, 11 and 14(2) and (3) of the Mediation Act 2017.

I make this solemn declaration conscientiously believing the same to be true for the purposes of section *14 *15 of the Mediation Act 2017 and by virtue of the Statutory Declarations Act 1938.

Signed: …….

Declared before me ……… [name in capitals] a *(Judge of the District Court) *(commissioner for oaths/practising solicitor) *(peace commissioner) *(notary public) by the said ……..

*[who is personally known to me]

*[who is identified to me by …….. who is personally known to me]

*[whose identity has been established to me before the taking of this Declaration by the production to me of

†passport no. ….. issued on the ….. day of. ………. by the authorities of ………, which is an authority recognised by the Irish Government,

†national identity card no. …… issued on the …. day of ……… by the authorities of ………. which is an EU Member State, the Swiss Confederation or a Contracting Party to the EEA Agreement,

†Aliens Passport no. ( ……… issued on the … day of…… by the authorities of …….. which is an authority recognised by the Irish Government,

†refugee travel document no. …… issued on the …. day of ….. by the Minister for Justice and Equality,

† travel document (other than refugee travel document) …… issued on the ….. day of …… by the Minister for Justice and Equality,]

At ……… this….. day of ……. 20…….

Signed: ……………

*Judge of the District Court *Commissioner for Oaths / *Practising Solicitor / *Peace Commissioner / *Notary Public

This statutory declaration has been filed with the District Court Clerk at …… on the….. day of ….. 20 ……..

*Delete where inapplicable

†Where relevant, provide details of the document by which identity has been established and delete the remaining alternatives.