MEDIATION PROTOCOL BEFORE : Alterys Law & Mediation Chartered Mediator: Chaussée de le Hulpe 177/19 B-1170 Brussels Tel : 02/541.18.50 Registration : 0832.130.138 BETWEEN : The Business Or Company’s name : Name of Representative: Or the name of the person running the business personally: Head office : BCE : Email : Eventual Counsel : AND : The Consumer Name : First name : Address : BCE or National number(see Sis Cart): Email : Eventual Counsel : We are aware that mediation is a method of non-binding dispute resolution in the sense that we enter into it freely and can terminate the process unilaterally at any time. We are aware that the purpose of mediation is to allow people who have a dispute to reach a mutually agreed solution. We have been informed that as there is a chartered mediator, any settlement agreement can be homologated by a court. We declare our wish to discuss the following matters in a mediation meeting: [to be completed] We shall ensure that discussions take place in an atmosphere of cooperation and mutual respect and that solutions are found that will not be at the expense of the other party. We agree to share, within the mediation process, any information that might be necessary to reach a fair settlement. We recognise that the task of the mediator does not allow him to fulfil the role of legal counsel, and that it is up to us to obtain legal advice from qualified professionals whenever necessary. We are aware that we will be able to seek homologation of the settlement agreement before the competent judicial authority, providing that the agreement is not considered contrary to law and order. We are conscious that the mediation process is incompatible with the introduction or pursuit of any legal proceedings between us. We therefore undertake to suspend all proceedings from then on, for the time of the mediation process. We recognise that in no case the mediator shall be able to testify in court on the issues discussed in mediation. The content of our meetings as well as the documents exchanged under mediation and their contents are confidential. In no circumstances can they be produced or presented to a Court, or before any other jurisdiction, neither by us, our counsel nor whomever, except for this Protocol and the settlement agreement dated and signed by each of us as well as any document certifying the failure of the mediation process. Moreover, nothing in this Convention shall affect in any way the right of the parties to use in legal proceedings (judicial or otherwise) documents relating to the case in question that have been exchanged in the current mediation process, when these documents were already in their possession or were at their disposal anyway and had, or could have had, the legal right to use them or refer to them. The mediator shall not be subpoenaed to testify in judicial proceedings or otherwise. The parties recognise him the right to remain silent. The mediator may, when he deems it appropriate, organise meetings in his office in Watermael-Boitsfort or Lasne, in plenary or aside ("caucus") with one or other of the parties, who may also, at any time, ask to discuss aside and confidentially with him. Mediation, being a voluntary process, may be terminated by notice of either party of its desire not to continue the process or, by notification of the mediator of his understanding that the mediation cannot be usefully continued. Upon the file’s opening, a set price of € 50.00 is paid by the party/parties seeking mediation to include and cover the first steps necessary for the implementation of the mediation. This amount will be taken into account when the final statement of fees is drawn up. For the BELMED’s cases only, the hourly fee charged by Alterys' mediators is as follows: - For disputes with an issue under or equal to, €1,860.00 : 80 euros/hour For disputes with an issue above or equal to, €1,861.00 : 10 euros/hour For disputes with an issue above or equal to, €10,000.00 : 150 euros/hour If the dispute involves three or more parties, the fee is increased by €50.00 per party. Unless otherwise stated, the fees and expenses shall be shared equally by the parties. Any additional expenses will be charged separately. The parties are jointly bound for Alterys’s fees and expenses. The mediator may suspend or terminate the mediation process if one of the parties does not pay the due expenses and fees. At the end of the mediation process, whether there is a settlement agreement or not, the mediator shall give each party a statement of costs and expenses, the final balance of which the payment is due within two weeks at the latest to Alterys bank account : Iban : BE91-3630-8206-5676 et Bic : BBRUBEBB. The parties accept the only jurisdiction of Brussels Courts in case of conflict and in any case the Juge de Paix du 2ème canton. FOR AND ON BEHALF OF, Executed in ..................................(place), on ..............................(date) in……(number) original copies, one for each party and their eventual counsel and one for the mediator, each of them acknowledging receipt of one.