THE STATE OF NEW HAMPSHIRE

JUDICIAL BRANCH
http://www.courts.state.nh.us

Court Name:
Case Name:
Case Number:
(if known)
COURT-ANNEXED FORECLOSURE MEDIATION PROGRAM
PRE-SUIT AGREEMENT TO MEDIATE/REPORTING FORM
By signing below, I acknowledge the following:
1. I understand that mediation is VOLUNTARY, and that I (BORROWER LENDER) have chosen mediation
as an alternative to litigation.
2. I understand that by VOLUNTEERING to mediate, I am doing so because I want to try to have this matter
resolved prior to a formal foreclosure action taking place.
3. I understand that the foreclosure process does not stop while I mediate (unless paragraph 5 below applies.)
4. I understand that I may choose, at any time, and for any reason, to end the mediation without penalty.
Furthermore, I understand that if I choose to end the mediation the matter may proceed as though no
mediation had occurred.
5. I agree that I will enter into the mediation session(s) in good faith and that all mediation proposals will be
made in good faith. I state that I have authority to mediate and to make binding decisions about this matter.
However I acknowledge that there may be some circumstances in which a loan modification or restructured
loan is subject to applicable state, federal or other requirements for which additional approval shall be sought
in a timely manner and in which case I agree to discuss whether or not to enter into a written agreement to stay
the foreclosure while the additional approval of the agreement is sought.
6. I understand that if I do reach agreement through the mediation process, the agreement is legally binding
and may be the subject of enforcement, if its terms are not honored by either party.
7. I agree that any settlement discussions are confidential and may not be used against either party in
subsequent proceedings. Failure to adhere to this provision could result in the imposition of sanctions by the
Court at the request of the other party or the mediator.
8. I understand that the mediation process is strictly confidential, and that no part of the discussion with the
mediator(s), is ever reported outside the program.
9. I agree that I will not subpoena the mediator(s) to testify in any court proceedings connected with the
mediation sessions(s) or other activities related to the Foreclosure Mediation.

Lender Signature Borrower Signature

Print name Print name

Counsel for Lender Counsel for Borrower

Mediator Other Interested Party

Mediator Other Interested Party

MEDIATION REPORT
Case Settled at Mediation
Case Did Not Settle at Mediation Date:

Signature of Mediator Mediator Name (please print)

NHJB-2382-OMA (11/20/2009)