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Applicant: (state name, gender, date of birth, address and other basic information)

Authorized Agent: ... (State name, work unit, position and other basic information)

Interviewee: ..... (State basic information such as the name and address of the unit)

Legal representative (or person in charge): ... (State name, position and other basic information)

Authorized Agent: ... (State name, work unit, position and other basic information)

If there is a dispute between the applicant and {\\ f 6527 .}, {\ F6527 {\ F6527. }

×××××× (specify the contents of the agreement, pay attention to the order of performance and enforceability)

The above agreement has been reviewed and confirmed by this Committee.

This mediation agreement shall come into force after being signed or sealed by both parties, signed by members of the mediation meeting and stamped with the seal of the mediation committee, and shall be binding on both parties, and both parties shall perform it. If one party fails to perform the mediation agreement, the other party may apply for arbitration according to law.

(If a mediation agreement is reached on the payment of unpaid labor remuneration, medical expenses for work-related injuries, economic compensation or compensation, this part shall state that the other party may apply for arbitration or apply to the people's court for a payment order in accordance with relevant laws and regulations. )

Applicant: (signature or seal)

Respondent: (signature or seal)

Chairman of the Mediation Committee: (signature)

Translation: (signature)

Translation: (signature)

This copy is the same as that on the original, and the contents on the original are as follows

(Seal of Mediation Committee)

Bookkeeper: (signature)

Extended data:

Relevant regulations:

According to "Several Provisions of the Supreme People's Court on Judicial Confirmation Procedure of People's Mediation Agreement":

Rule number one If the parties apply to the people's court for confirmation of the mediation agreement in accordance with the provisions of Article 33 of the Resolution of China People's Opinion Poll, the people's court shall accept it according to law.

Rule number two Where a party applies for confirmation of a mediation agreement, it shall be under the jurisdiction of the local people's mediation committee presiding over the mediation or the grassroots people's court dispatched by it.

Before placing a case on file, the people's court shall designate a people's mediation committee to conduct mediation and reach a mediation agreement. Where a party applies for judicial confirmation, it shall be under the jurisdiction of the designated people's court.

Rule three. Where a party applies for confirmation of a mediation agreement, it shall submit to the people's court an application for judicial confirmation, a mediation agreement, proof of identity, proof of qualification, proof of property rights related to the mediation agreement and other supporting materials, and provide the service addresses, telephone numbers and other contact information of both parties. Where an application is entrusted to another person, a power of attorney signed or sealed by the client must be submitted to the people's court.

Baidu Encyclopedia: Mediation Agreement

People's Court: Several Provisions on Judicial Confirmation Procedure of People's Mediation Agreement