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Mediation/Arbitration

NTA form for mediation and arbitration

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Republic of the Philippines
Department of Agriculture
NATIONAL TOBACCO ADMINISTRATION
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MEDIATION / ARBITRATION
Date Requested: ________________________
Name of Complainant Farmer: ______________________________________________________
Address: _______________________________________________________________________
Area planted (ha): _________________
Type of Tobacco Produced: __________________
Name of Respondent Buying Station / Buyer Firm (Market tie-up): __________________________
Nature of Complaint:
Improper Grading

Buying Below Floor Price

Improper Weighing

Others (Specify) ________________

Brief Statement of Facts: __________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Did the parties agree to settle between themselves?

Yes

No

If no, state recommendation:______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

I/we hereby affix my/our signature/s below to affirm that I/we agree and comply with the
settlement/resolution made by the Mediator/Arbitrator.

Complainant: ________________________
(Signature over printed name)

Respondent: ________________________
(Signature over printed name)

Witnesses:
________________________________
For the Complainant

__________________________________
For the Respondent

ATTESTED BY:

NTA Mediator/Arbitrator: __________________________
(Signature over printed name)
Date: ___________________________
 
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