Mediation Confirmation

Respondent:
Legal representative:               Tel.
Address:                          Postcode:
E-mail:

This is to acknowledge the receipt of the Notice of Mediation No.____Tiao (_____________) and confirm our agreement to mediation of the dispute by the CCPIT/CCOIC Mediation Center and our appointment of_______________________as a mediator.

Respondent or authorized attorney: (signature)

Company seal:

_________________________(date, month, year)