Request for Arbitration

CLAIMANT'S BUSINESS DETAILS

Business Name*

Nature of Business*

Business Email Address*

Location*

Postal Address*

Postal Code*

City/Town*

CLAIMANT'S REPRESENTATIVE

Name*

Telephone*

Postal Address

Postal Code

City/Town

Email*

RESPONDENT'S BUSINESS DETAILS

Business Name*

Nature of Business*

Business Email Address*

Location*

Postal Address*

Postal Code*

City/Town*

RESPONDENT'S REPRESENTATIVE

Name*

Telephone*

Postal Address

Postal Code

City/Town

Email*

DISPUTE DETAILS

1. Copy of the contract*

2. Brief statement describing the nature and circumstances of the dispute giving rise to the claim, and specifying the relief sought by the claimant against the respondent. Please attach below*

3. Statement specifying the seat and language of arbitration, as agreed to in writing by the parties or as proposed by the claimant to the respondent. Please attach below*

4. Confirmation document addressed to the Registrar, that copies of the request for arbitration and all supporting documents have been served on all parties to the arbitration and the means of service used or intended to be used*

5. Attach proof of payment of registration fees*

CLAIMANTS'S NOMINEE (ARBITRATOR) - OPTIONAL

Name

Nationality

Qualifications

Telephone

Fax

Email

Postal Address

Postal Code

City/Town

NB: Application must be accompanied by a non-refundable fee as prescribed in the Fee Schedule