Forms for mediation

Contact

For all farm debt mediation requests, notices and applications, farmers and creditors may use forms approved by the Secretary of the Department of Jobs, Precincts and Regions.

For general information on the forms, contact a Farm Debt Mediation Officer on 136 186 or farm.debt@ecode.vic.gov.au

All requests for mediation need to be sent to:

farm.debt@ecodev.vic.gov.au

OR

Farm Debt Mediation Officer
PO Box 2392
Level 26, 1 Spring Street
Melbourne, Victoria, 3000

Forms related to creditor-initiated mediation:

• Form 1 - Section 8: Notice to Farmer - Notice of Availability of Mediation (WORD - 36.5 KB)
• Form 2 - Section 9: Notice to Creditor/Bank - Request for Mediation Concerning Farm Debt (WORD - 29.5 KB)
  
  Form 3 - Section 11: Notice to the Department that Mediation is Required (WORD - 39.0 KB)
• Form 6 - To Creditor or Department of Decision not to Enter into or Proceed with Mediation (WORD - 26.5 KB)

Forms related to farmer-initiated mediation

• Form 7 - Section 9(2): Notice to Creditor Request for Farmer-initiated Mediation Concerning Farm Debt (WORD - 34.5 KB)
• Form 8 - Section 10(1): Notice to Farmer Agreement to Enter into Farmer-initiated Mediation/ or Refusal of Request to enter Farmer-initiated Mediation (WORD - 28.0 KB)
• Form 9 - Notice to Department that Farmer initiated Mediation is Required in Respect of Farm Mortgage (WORD - 41.0 KB)

Farmer application for a prohibition certificate

Form 10 - Section 13: Application for Prohibition Certificate (WORD - 43.5 KB)

Creditor application for an exemption certificate

Form 4 - Section 15: Application for Exemption Certificate (WORD - 58.0 KB)

Related information and documents

The following resources should be included with a Form 1 notice of availability of mediation.

• Mediation Guide
• Farm Debt Mediation – Talk can be cheaper (WORD - 18.1 KB)
• The contact list for the Victorian Rural Financial Counselling service