Means Test Application Form

Justice Through Mediation

Means Test Application Form

Criteria

Applicants
Applicants must:

Be an individual or a small business registered in South Africa.
Have a dispute that falls within AFSA’s defined financial threshold.
Provide proof of financial position to demonstrate that payment of mediation fees would cause hardship.

Financial Thresholds
For Individuals:

Annual gross income not exceeding R180 000,000 (or about R15,000/month).

For Small Businesses:

Annual turnover not exceeding R1 million.

This form is to be completed by individuals and small businesses applying for free mediation under AFSA’s Justice Through Mediation programme. Please complete all sections clearly and attach the required supporting documents. Eligibility will be assessed against the programme’s financial thresholds and subject to the discretion of the retired judges and lawyers supervising the initiative.

Section 1: Applicant Information

Full Name:(Required)

First Last

ID / Registration Number:(Required)

Contact Number:(Required)

Email Address:

Physical Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Section 2: Type of Applicant

Type of Applicant(Required)

Individual

Small Business

Section 3: Financial Information (Individuals)

Monthly Gross Income: (R)(Required)

Other Sources of Income: (R)(Required)

Total Household Income: (R)(Required)

Section 4: Financial Information (Small Businesses)

Annual Turnover: (R)(Required)

Net Profit Before Tax: (R)(Required)

Section 5: Supporting Documentation

Please attach the following:
For Individuals:

Certified copy of ID
3 months’ bank statements
Latest payslip(s) or proof of income
Proof of assets and liabilities

For Small Businesses:

CIPC registration certificate / business license
Latest financial statements or management accounts
3 months’ bank statements

Upload Supporting Documents(Required)

Drop files here or

Max. file size: 128 MB.

Section 6: Declaration

I, the undersigned, declare that the information provided in this application is true and correct to the best of my knowledge. I understand that providing false or misleading information may result in disqualification from the programme. (Required)

Date(Required)

Register an Arbitration case

International Arbitration

Domestic Commercial Arbitration

Domestic Expedited Arbitration

Register a Mediation case

Mediation

Administered Mediation

Justice Through Mediation