PMC-CA Form 3 - Agreement to Mediate

Republic of the Philippines

PHILIPPINE MEDIATION CENTER
Manila
_____________ Division
_________________________
_________________________
_________________________
____________,

CA-G.R. __ NO. ________

Members:
_______________, Chairman
_______________
_______________

- versus _________________________
_________________________
____________,

x-----------------------------------------------------------x
AGREEMENT TO MEDIATE
Undersigned parties, having appeared before the Court-Annexed Mediation (CAM) as directed by
the Municipal Trial Court and pursuant to the Notice to Appear issued by the Division Clerk of Court in
accordance with the Revised Guidelines for the Implementation of Mediation in the Court of Appeals
issued by the Supreme Court under A.M. No. 04-3-15 SC PHILJA dated March 23, 2004 (Resolution No.
04-04),
And having carefully considered the benefits and advantages of mediation as fully explained to
them,
Hereby agree of their own free will to have their case be mediated for possible settlement of
their dispute by the CAM.
_________________, 2006 at Manila.

____________________________
Appellant (Petitioner)
ATTESTED:
___________________
Division Clerk of Court

_______________________________
Appellee (Respondent)