Schedule 1
.................Judgeship Mediation and Conciliation Centre(Consent to he furnished for empanelment)Name :Father's name :Address : (a) Office :Telephone No. (a) Office :Academic Qualifications :Professional Qualifications and Experience :Technical experience, if any :Special qualification or experience in mediation :Enrolment number with date and the Bar Council :I........,do hereby submit that I am willing to be empanelled as a mediator in........Judgeship and give my consent for my empanelment under Rule 4 of the Uttar Pradesh Civil Procedure Mediation Rules, 2007. I assure that during my term as mediator, I shall follow ethics as prescribed in Rule 28 of the said Rules while performing my duties as mediator.Full SignatureDate :
Schedule 2
...........Judgeship Mediation and Conciliation Centre(Case sheet furnished by the Court to the centre)2. Name of the Presiding Officer referring the matter :
6. Contact information of Parties :
7. Names and Contact Information of Counsel :
8. List of documents annexed to case sheet :
(To be prepared and signed by the Reader of the Court concerned)
Schedule 3
............Judgeship Mediation and Conciliation Centre(Written notice to the parties and their Counsel)1. The referral of the case by the Court for mediation.
3. Information about the process of mediation.
5. That the parties may object to the mediator appointed giving their reasons for doing so within a fixed time
6. Date and time of mediation session.
(To be prepared, signed and issued by the senior most clerk in the centre in consultation with the mediator)
Schedule 4
.............Judgeship Mediation and Conciliation Centre(Information Sheet furnished to the Parties)Case Name :Case Number:Name of Mediator :1. This mediation is being conducted with the purpose of arriving at an acceptable resolution by settling the dispute in a co-operative manner. Parties should participate in this in good faith.
2. The mediator will inform the parties of the time and date of the mediation sessions
3. (a) The parties residing in India agree to -
(i)attend the mediation sessions personally; or(ii)be represented at the mediation sessions by their constituted attorney with authority to settle the dispute(Strike off whichever is not applicable)(b)The parties not resident in India agree to be represented at the mediation sessions by their constituted attorney or Counsel with authority to settle the dispute.4. The mediator shall respect the confidentiality of information that the parties request him/her to keep confidential.
5. The parties shall not rely or introduce as evidence in any proceedings the view, suggestions or admissions expressed or made by a party, the proposals made by the mediator and indication of acceptance by a party during the course of the mediation proceedings.
6. The parties agree not to call the mediator as a witness or as an expert in any proceeding relating in any way to the dispute, which is the subject of mediation.
7. If the parties reach a settlement, they shall sign an agreement to that effect and this shall be filed into the Court.
8. The entire process is a voluntary' process and until parties reach settlement and sign an agreement, any party is free to opt out of the process
9. If the parties fail to reach settlement, the matter shall be referred back to the Court
(To be signed and dated by each party and the learned Counsel identifying them).
Schedule 5
............Judgeship Mediation and Conciliation Centre(Settlement Agreement)This Settlement Agreement entered into on.........between.........Advocate and ........identified by Sri.........AdvocateWhereas1. Disputes and differences had arisen between the parties hereto and ...........(Case No.) was filed on.........(date of institution) before..........(give particulars of the Court concerned);
2. The matter was referred to mediation vide an order dated .............passed by (name and designation of the Presiding Officer concerned).
3. The parties agreed that Sri...........(name of the Mediator) would act as their Mediator.
4. Meetings were held during the process of Mediation from..........to ..........and the parties have with the assistance of the mediator voluntarily arrived at an amicable solution resolving the above mentioned dispute and differences.
5. The parties hereto confirm and declare that they have voluntarily and of their own free will arrived at this Settlement/Agreement in the presence of the Mediator.
6. The following settlement has been arrived at between the parties hereto :
A ................B ................C ................7. By signing this agreement the parties hereto state that they have no further claims or demands against each other with respect to...........(Case No.) and the parties hereto through the process of Mediation in this regard have amicably settled all disputes and differences.
Parties full signature with date :Counsel's full signature with date :(Additions/alterations in the form as per requirement arc permitted)
Schedule 6
..........Judgeship, Mediation and Conciliation CentreReport to Court4. Mediators : (a)
(c)5. Date (s) of Mediation Sessions :(i)Mediation completed, Agreement enclosedOr(ii)Mediation completed, no agreement.Or(iii)Parties not willing for the Mediation.6. The parties have been directed to appear before the Court on..............
Signed by Mediator(s)Dated :