[THIS AGREEMENT]

Party A

………………………………………………………………………………………………………………………………………… of …………………………………………………………………………………………………………………………………………

Party B

………………………………………………………………………………………………………………………………………… of …………………………………………………………………………………………………………………………………………

(together referred to as "the Parties")

The Mediator 

………………………………………………………………………………………………………………………………………… of …………………………………………………………………………………………………………………………………………

(a term which includes any agreed Assistant Mediator)

and

CEDR Solve of IDRC, 70 Fleet Street, London EC4Y 1EU                                                

in relation to a mediation to be held 

on ………………………………………………………………………………………………………………………………………………………………………………………………………………

at ………………………………………………………………………………………………………………………………………………………………………………………………………………

("the Mediation")

concerning a dispute between the Parties in relation to    

……………………………………………………………………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………………………………………………………

 ("the Dispute")

IT IS AGREED by those signing this Agreement THAT: