Mediation Format
Mediation Format
Mediation Format
Jharkhand State Legal Services Authority (JHALSA), Near A.G. Of8ce, Doranda, Ranchi- 834002
Phone: 0651-2481520 (O), 2482392, Fax: Z482397, E-mail - jhalsaranchi@gmail.com
Yours faithfully
Settlement/Aqreement
J Date :
Present: Complainant X in person (hereinafter referred as wife) alongwith her father and Advocate.
Accused Y (hereinafter referred as husband) in person alongwith his father and Advocate.
Briefly stated, the relevant facts of the case as disciosed by the panies, are that the wife and the'
Husband got married on according to Hindu rites and customs. Twin issues one daughter namely
and one son namely bath aged about Z years were born from the said wedlock. Both lie children
are Ïh the care and custody of wife at present. Certain matrimonial differences have stated to be arisen beMeen tÎ1e
paRies.
Husband has filed a custody petition under section 25 of Guardianship and Wards Act, ,
The wife has filed a Petition u/s 12 D.V. Act titled as Vs , penöiag in
The wife has also filed a criminal complaint side FIR No. , U/s 498/\/406/34 IPC,
and
the same has Daen referred br r ediaüon. " "
After negoDations, the wife and the husband have ag«d to settle their disputes as föllows.
1) It is agreed fhat the wife and Husband shall dissolve their ma«iage b/ dec/ee ol bi nrce b/
mutual consent without leveling allegatans and counter-dlegations against each other in
2) It is agreed that the husbard shall pay Rs. (in wrds) to the wife towards her
all legal entit/emanb past, present and future arising out of the marriage which shall inciude
permanent aliiTloriy, maintenance, lstndhan, Maintenance of both the children till their age of
majonty as per iaw and all other miscellaneous and legal expenses.
3) It Ts agreed that the wifa and the husband shall initiate appropriate legal proceedings before
the couit of competent jurisdiction at Courts for recording of First Motion on
or below . It is further agreed that at the ti«›e of recording of First Station,
Rs. {in words) in casNDD shall be paid by the husband to be wife before the
said court.
4) It is agreed that husband arid wife shall init apprqpnate
legd proceedings for reroding of Second Motion before the court of competent
jurisdiction at Courts within stipulated period in accodance with law. It is
further agreed tha at the time of recording of Second Motion, Rs. (in words) in
cash/00 shall be paid by the husband to the wifé befbe the said cou/t.
6) lt is agreed that the wife shall have permanent custody of both the children namely
and , The husband shall De entitled for visitation rights in respect of
both ke children namely and . ard br allied the husband sf›aIl meet
them four times in a calendar year by giving one week prior information to the wife at a
convenient place in the presence ol wife or any eldeily parson of 1e family atleast for a period
of N/o hours. It is further agreed between the parties that for tfis purpose of communication
between the parties the wife and husband shall be contacting through email or any other
rriode of com«iuni on. The email ID of husband is and ttie email
ID of wife is It is further agfeed, if there is any change in the
residential addess or contact number of either of the party, the same shall be communkatad
b tfe respective parly within 3 days of that change,
10) It is agreed that in view of the pesent settlement, the wife shall withdraw the present
petition u/s 12 of D.V. Act titled as .Vs. , , pending in Co«/t of.
, and the husband shall withdraw the custody petition under section 25 of
Guaidianship and Waids Act, 1925 titled as Yr , , pending in
Court of. , on ttair respective dates of hearing.
11) The wife and the husband with the assistance of their respective counsels shall
cooperate in the execution of the tems and conditions of this settlemeht.
12) lt is seNed that after compliance of the terms of the present settlement, there shall
remain no dispute due between the parties ansing out of tha said marriage and that none of
the parties shall file any civil or criminal proceedings against each other in ftJtMre arid that if
any other case/petition/complaint etc. between the parties is perxling in any Court or Authority,
the same shdl be withdrawn/got disposed of by the respective party
13) The parties have settled their dispute out of their own frae will, without any fear,
force, coercion or undue influence from any side.
Complainant Accused
«d›oras. Advocate.
The content of the settlement wave been explained to the parties in vernacular and they have
understood the same and have admitted tf›s sabre to be correct,
SeNement proceedings be sent b the referral courts. Parties to appear below be Referral cart at.
on ib next date of hearing i.e.
Copy of settlement be given to both the pai1ies. Copy of IN settlement be also sent to the cohcemed
courls in connected case.
"
{Signature of Mediator)
Mediation Agreement in Matrimonial IYlatters
" Format-2
Settlement/Agreement
Date
Negotiations held.
Briefly stated, the relevant facts of the case as disclosed by the parties, are that the wife and the
Husband got married on. according to Hindu rites and customs. No issue was born out of the said wedloct,
Certain matrimonial differences have stated to be arised between the parties.
The wife has filed a Petition u/s 12 of D.V. Act titled as X Vs. Y, pending in Court of. and the same has been
The wife has also filed a Petition bearing no. titled as X Vis Y u/s 125
After negotiations, the wife and the husband have agreed to setts lheir disputes as follows:
1)lt is agreed that the wife and Husband shall dissolve their marriage by decree of divorce by
mutual consent without leveling allegations anâ counter-allegations against each other in
accordance with law.
2) It is agreed that the husband shall pay Rs. (in words) to the wife towards her
all legal entitlements past, present and future arising out of the marriage which shall include
permanent alimony, maintenance, and all other miscellaneous and legal expenses,
3) lt is agreed that the wife and tfte husband shall Initiate appropriate legat proceedings before
the court of competent jurisdiction at for recording of First Motion on or
before . It is further agreed that at the time of recording of First Motion, the
husband shall pay Rs, (in words) in cashlDD in the name of wife.
5) lt is agreed that in case wife commits default for recoiling of second motion, in that
eventuality, she MII se liable to refund back R............../- as to be received by her at the 1
time of decoding of statements in first motion. It is further a0Red thd in case, the husband
commits default in recording of staterrterit in Second Motion, in that eventuality, the wife shall
be entitled to retain Rs.........,......../- so received by her at the time of recording of first
motion.
6) Tt is ag/eed that in view of the present settlement, the wife shall withdraw the present case
fr0m the referral coult as well as the connected case pending in the court of.
, after recording of Secand Motion and till then wife should not prosecute or
continue with the trial of present case refered for mediation. However, in case of default as
mentoned hereinabove, the wife shall be at liberty B co»tihue with the trial of case refefled for
mediation.
7) The wife and the husband with the assistance of their respective counsels shali
cooperate in the execution oftf›e te/ms and conditions of this settlement.
8) It is settled that after compliance of the ferrets of the present settlement, the shall
femain no dispute due between the parties arising out of the said marriage and that none of
the parties shall file any civil of criminal proceedings against each other in Mure and that if any
other case/petition/complaint ek. between the parties is pending in any Court orAutho/ity, the
same shall be withdrawn/got disposed of by the respective party,
9)The parties have sdtled tfteir dispute out of their own free will, ithout any fear, force,
coercion or undue influence from any side.
Complainant Respondent
Advocate.
" The contents of the seNement have been explained to the partie's in vemacMar and thay have
understood the same and have admitted the same to be co«ect.
Settlement proceedings be sent to the referral court. Parties to appear before the referral Court on the
next date of hearing i.e. for further direction. Copy of settlement be givan to both the parties. Copy
of the settlement be also sent to the concerned courts in connected case.
(Signature of mediator)
Settlement/Agreement
Date:
Negotiations held.
Briefly stated, the relevant facts of the case as disclosed by the partfes, are that the wife and
the Husband got married on accordihg tO Hindu ‹ites and customs, No issue was born out of
the said wedlock. The matrimonial dispute has been arisen between the parties, as a result of which the wife
and the husband initiated legal proceedings against each other. The petitioner wife has filed a petition u/s 125
Cr.P.0. bearing no. titled as Vs. which is pending in the court of
, and is baing referred for mediation. The wife has also initiated criminal proceedings vide FIR
No. u/s 498/406/34 IPC at P.S. and after completion of investigation, the trial
is pending befote the court of concerned Judicial Magistrate, . The husband has also filed a petition
for grant of divorce titled as Vs. which is now pending in the court of Sh.
After negotiations, the wife and the husband have agreed to settle their disputes as follows:
1) lt is agf ed that the wife arid Husband shall dissolve their marriage by decree of
divorce by mutual consent without leveling allegations and counter-allegations against
each other in accordance with law.
2) lt is agreed that the husband shall pay Rs,.........../- (Rupees .. ....., ... Only) to
the wife towards her all legal entitlements past, present and future arising out of the
marriage with husband which shall include permanent alimony, maintenance, arrear of
maintenance, Istridhan and all other miscellaneous and legal expenses,
S)lt is agreed that the wife and the husband shall jointly initiate appropriate legal
proceedings lot quashing of FIR bearing no, u/s 498A/406/34 IPC P.S,
and at that time the husband shall pay Rs. (in words)
by way of Demand Draft in the name of wife.
6) It is agreed that the wife and the husband shall withdraw their respective cases as
mentioned hereinabove immediately after the dissolutim of marriage by decree of
divorce by mutual consent.
7) The wife and the husband with the assistance of their respective counsels shall
cooperate in the executioh Of the terms and conditions of this settlement.
8) lt is settled that after Compliance of the lerms of the present sifflement, there shall
remain no dispute due between the parties arising out of the said marriage and that
none of the parties shall file any civil or crirninal proceedings against each other in
future and that if any othar case/petition/complaint etc. between the parties is pending
Ïh any Court or Authority, the same shail be withdrawn/got disposed of by the
respective party.
9) Tñe parties have settled their dispute out of their own free will, without any fear,
force, coercion or undue in9uence flora any side.
Petition Responde
Fatter/ReIative of Father/Relative of
Advocat Advocat
The contents of the settlement have been explained to the parties in vernacular and they have
understood the same and have admitted the same to be correct.
Settlement pr0ceedings be sent to the referral cout. Parties to appear before the Court
concerned for further directions.
Settlement / Agreement
Negotiations held.
Brief facts of the present case as disclosed by the panies are that on DATEat about TlMEa.m
a(PLACE, Respondent no. 1 was driving a vehicle bearing no. and hit against
which caused fatal injuries to him. The petitioner filed the present claim case which is pendln
in the coun of Sh. the same is referred for mediation.
The concerned parties, After deliberation have agreed to settle the present case on the
“ following tems and conditions:
2) That, it is settled that after receipt/payment of the total settled amount, there shall
remain no case/claim/dispute due between the petitioners and Respondent No.3 in the
present claim case and that none of the parties shall file any other case/claim against
each other in future qua the present claim case.
3) That, the parties have entered into the present settlement/agreement out of their
own free will, without any fear, coercion or undue influence from any side.
Advocate
for petitioner no. 1
Advocate
for petitioner no. 3
The contents of the settlement have been explained to the parties in vernacular and they have
understood the same and have admitted the same to be correct,
Settlement proceedings be sent to Ld. Court concerned. Partles to appear before Court
concerned on for further directions.
Settlement/Agreement
Brief facts of the present cases as disclosed by the parties are that a FIR bearing no. ,
u/s 279338 IPC @Ot registered in P.S. on the allegation that the accused/Oliver whi(e driving
bthe vehicle beafihg let. on DATEat TIMEat PLACEcaused injuries to XYZ.
The concerned I.O., after investigation had filed a DAR tifl9d as XYZ VS. ABG beahng suit No.
which is pending in the court of Sh. , and the same is being referred for mediation.
After negotiations, the the concerned parties have agreed to settle their disputes as follows:
1)It is agreed ttiat the respondent no. 1/Driver and Respondent no. 2/owner shall jointly pay
Rs. (in wads) in cash to the injured XYZ as full and final compensation on
account of injuries received by him due to the above mentioned accident ard the
compensation shall include medical expenses, compensation on account of oriental pain and
agony, diet and conveyance charges and all other miscellaneous and legal expenses. It is
further agreed that out of the total settled amount off the respondent no. 1/Driver
and Respondent no. 2/owner shall pay Rs. on to the
injured before the court of Sh. , Judge MACT, Courts and
Rs._ befoe the courtofsh. , on at the
time of the compounding of the offence punishable ups 338 !PC.
2) It is agreed between that after the receipVpayment of the total settled amount of
Rs._ there shall remain no case/daim/dispute due between petitioner and
Respondents artd that none of them shall file any other case/claim against each other in future
qua the present claim case and criminal Case and It is further agreed that Respondent
no.1/Driver shall initiate appropriate legal pmeedings for compounding of FIR bearing no.
, u/s 279/338 IPC P.S. and in the said proceedings, the injured
XYZ
shall cooperate with the respondent h0. 1/driver.
3) The parties have settled their dispute out of their own free will, without any fear, force,
coercion or undue influence from any side.
!Petitioner Respondent 00. 1/Driver and Respondent no. 2/ouner of
the vehicle
The contents of the settlement have been“ explained to the parties in vernacular and they have understood the
same and have admitted the same to be correct.
Settlement proceedings be sent to the referral court as well as in the concerned court. Parties to
appear before the referral court on for further directions.
Settlement/Aqreement
Accused/driver in person.
Brief facts of the present case as disclosed by the parties are that on DATEat about TIMEat
, PLACEaccused was driving a vehicle/Truck bearing No. and caused grievous injures
IO
The accused was booked for the offences U/s.2?9/338 APC vide FIR bearing no. at PS
The trial is pending before the court of Sh. , and the same is being refered for
! mediation.
After negotiations, parties have agreed to seNe their disputes on the (ollowing terms and conditions:
1) Injured has agreed to compound the offence u/s 338
IPC with the accused/driver
for which the accused/driver Shall pay Rs. (II
words) to the injured in cash before the referral court on.
2) \t is a9reed that, after the re¢eipt/payment of the total settled amount, appropriate
proceedings shall be initiated before the Court concerned for compounding the offG'nce
3) The parties have settled their dispute out of their own free will, without any fear,
force, coercion or undue influence from any side.
Injured
Accused/driver
'
The Contents it the seElemet hve been e laine to the pales in v acular and thy have understood the
and have admitted the same to be co act.
Settlement/Agreement
Briefly stated, the relevant facts of the case as disclosed by the parties are that the accused
issued cheques total amounting to Rs. in favour of complainant which on presentation got
dishonoured. Thereafter, the complainant have filed 3 complaints u/s 138 NI Act as detailed hereinabove I
which are pending in the court off , and the same are referred for mediation.
After hegotiations, the concerned parties have agreed to settle their all disputes as undef:
J)lt is agreed that the accused shall pay Rs. {in words) by may of
DD/Cash to the complainant towards full and final satisfaction of the cheque amount,
outstanding dues including Principal amount, interest thereon, legal and
miscellaneous expenses.
3) It is agreed that after the receipVpayment of the entire settled amount, the
complainant shall withdraw the present complaints as mentioned hereinabove from the
referral court.
4) lt is agreed that in case of three defaults, the complainant shall be entitled to
continue with the trial of the present cases ard the amount paid so far bt the accused
shall be forfeited by the complainant.
5) lt is settled that after the receipt/payment of the total settled amount, there shall
remain no dispute behreen the parties and that none of the parties sha(I file any civil or
criminal proceedings against each other ir future arising out of the present cases.
6) Both the parties have settled their dispute out of their own frea will, without any fear,
force, coercion or undue influence from any side,
complainant accused
1. 1.
2. 2.
3. s.
Signature of the Petitioner/First Party Signature of the O.P./Second Party
Date : Date :
I identify that Petitioner/petitioners named above
I identify that O.P/O.Ps named above puthis/tier signature
put his/her signature in my presence .
Signature of MediatorfMediators :
2.
3.
Format-2
Settlement/Aareement
Briefly stated, the relevant facts of the case as disclosed by the parties are that the
accused issued cheques total amounting to Rs. in favour of c0I+iplainarit WhlCb Dn
presenatongo öshonoured. Theeaher,the companmitavetiedinsan!compantvs 138 N!Ac
as detailed hereinabove which is pending in the coun of , and the same is referred
for mediation.
After negotiations, the concerned parties have agreed to settle their all disputes as
under:
3) lt is agreed that the instant Ccnplaint Case will stand disposé of on lie basis
of this compromise,
4) lt is agreed that in case of Chèques being again dishonoured , the
Complainant shall be at liberty to fite execution case for realisation of the dues
amount . The Complainanl may Ile any othet appropriate case.
6) 8oth the parties have settled their dispute out at their 0Wn Free will, wÏthout
any fear, force, coercion of undue influence from any side.
complainan
t accused
Settlement proceedings be sent to Ihe Referral Court. The parties to appear before Ihe
referral Court on the next date of hearing i.e. lot further directions. Copy 0t
settlement be given to both the parties.
1 5
/ /{ T/gT
*”
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