This document is a form used in family court proceedings in England and Wales to provide information about mediation. It requires information about whether the applicant attended a required Mediation Information and Assessment Meeting, the reason if they did not attend, and signatures from the applicant's legal representative and the mediator if applicable. The form has four parts - Part 1 is checked if the applicant attended the meeting, Part 2 provides reasons why not if determined by the mediator, Part 3 provides additional reasons why not from the applicant's perspective, and Part 4 allows for reasons not covered in Parts 2 or 3.