New Mediation Code in Thailand - Appendix 4


Each person who is a party to the Mediation of the dispute identified below, or who is present at the Mediation, hereby agrees to be bound by this Statement of Understanding.
The Mediator indicated below has been assigned to mediate this dispute. S/he will serve as a neutral party to help the parties resolve the dispute. S/he will not act as an attorney or advocate for any party.

For each party: If you reach an agreement in Mediation, you may wish to consider having an attorney independently review the agreement before you sign it. If you do not wish to have the agreement reviewed by an attorney, you are not required to do so.

These Mediation proceedings (including any statement made in, or document prepared for, these proceedings) are privileged and shall not be disclosed in any subsequent legal or arbitral proceeding or any subsequently prepared document. No statement made in, or document prepared for, them shall be construed for any purpose as an admission against interest. The phrase "document prepared for these proceedings" shall not apply to any settlement agreement that may result from this Mediation.

Each individual who signs below agrees not to request (subpoena) the Mediator or the other party(ies) to testify regarding statements made in, or documents produced for, these Mediation proceedings. In no event shall a Mediator or a party voluntarily give such testimony.

If a settlement is reached, the agreement shall be reduced to writing and, when signed, shall be binding upon all parties to the agreement.

Please sign below to acknowledge that you have read and understand this Statement.


Printed names and Signatures of Parties in the Mediation proceeding: (Specify Title/Role for each)


Printed names and Signatures of other persons at the Mediation proceeding: (Specify Title/Role for each)


Description of dispute:


Printed Name and Signature of Mediator: