Mediation nº ____________


The MEDIARE Chamber, hereinafter “Chamber”, the parties and their legal advisors and assistants (if present), all of which are a dully qualified in the end of this instrument, voluntarily consent to Mediation, as the designated dispute resolution method, by the following terms and conditions:

I – Subject Matter

I.1. Guided by freedom of choice, the PARTIES hereby agree to appoint the MEDIATORS (identified below) and to hire the services offered by the MEDIARE CHAMBER.

I.2. The contracting parties agree that this form shall be governed by the MEDIARE CHAMBER Regulationon Ethical and Procedural Standards for Mediation(“Regulation”) and by the CONIMA – National Council of Mediation and Arbitration Institutions – Code of Ethics for Mediators (“Code of Ethics”).

I.3. The participants, with the mediator’s concurrence, shall determine the scope of the mediation and this will be accomplished early in the mediation process in the Preliminary Information Mediation Form (“Form”); as for the motivation, this shall be detailed in the end of this instrument.

I.4. All fees and expenses related to the Mediation procedure are detailed in the Mediation Service Proposal (“Proposal”), hereby ratified by the participants. The end of this instrument better identifies the values and payment responsibility.


II – Chamber’s Duties

II.1. The Chamber shall assist the participants with effectiveness and diligence as provided in the Regulation. 


III – Mediator’s Duties

III.1. The MEDIATORS shall assist participants to reach agreement in a collaborative, consensual and informed manner by guaranteeing that there is a balanced and active participation among the parties. Since the mediator cannot render individual legal advice; the participants shall be strongly advised to obtain independent legal review of any mediated agreement before signing that agreement.

The MEDIATORS shall also ensure the procedure’s independence and impartiality by attesting them in own document.


IV.1. The Parties hereby undertakes to act with an active and collaborative posture in order to achieve mutual-benefit solutions. Good Faith and endeavor to pursuit auto composition constitutes the basis for Mediation.

V – Confidentiality

V.1. It is understood between the participants and the mediators that the mediation will be strictly confidential, except as provided below or in the Confidentiality Term.

V.2. The Mediator shall not to testify concerning the mediation or to provide any materials from the mediation in any court proceeding between the participants. However, The participants understand the mediator has an ethical responsibility to break confidentiality if s/he suspects a party or another person may be in danger of physical harm.


VI – Assistance

VI.1. The participants may agree, by consensus, that the PARTIES are entitled to receive legal or any other technical assistance throughout the procedure, or be accompanied by people they trust; case in which they will also undertake to agree with the procedure’s principles.

VI.2. In case of absence of any of the assistants during the meetings, the participants shall negotiate whether or not to continue that meeting.

VII – Meetings and minutes

VII.1. The meetings may be conducted jointly or individually (ensuring equality between the parties), at the discretion of mediators and by consent of the parties.

VII.2. Minutes regarding the meetings shall be made available to the parties through a consensual agreement in this sense, given by the mediators.

VII. 3.  If agreed, the MEDIATORS may elaborate an e-mail with the meeting’s main matters, ensuring the respect for confidentiality.


VIII- Litigation

VIII.1. The participants agree to refrain from pre-emptive maneuvers and adversarial legal proceedings, while actively engaged in the mediation process.


IX – Location and Language

IX.1. Unless otherwise agreed, Mediation meetings will be conducted in Portuguese and take place in the Mediare Chamber.


X – Final Terms

X1. The procedure will end by the signing of a final mediation agreement that shall indicate the procedure’s beginning and ending date, as well as the agreements and compromises assumed by the participants as well as the suspension and/or withdraw term, if existent.

X.2.Suspension and withdraw may be requested by any of the parties, at any time of the procedure, with no need of informing the reason; or by the mediators as provides the regulation.

The respective term shall be drafted and signed by all the participants involved.

Rio de Janeiro,

Dated this ____ day of ________, 2018