Here you can download the model for the request for arbitration

REQUEST FOR ARBITRATION

CEPANI npo
Belgian Center for arbitration and mediation
Rue des Sols 8
1000 Brussels

Claimant:
(name, first name and name in full, description, address, telephone and fax numbers, e-mail addresses and VAT number)

having as counsel:

Hereinafter the “Claimant”

presents to CEPANI and following the Rules of CEPANI, as from the introduction of the request to the resolution of the dispute between him and:

The Respondent:
(name, first name and name in full, description, address, telephone and fax numbers, e-mail addresses and VAT number)

having as counsel:

Hereinafter the « Respondent »

* * *

Considering the CEPANI Rules in force as from the 1st of January 2005.

With all proper reserves and without any prejudicial recognition

* * *

The Request for arbitration is based on the following facts :


I. A RECITAL OF THE NATURE AND CIRCUMSTANCES OF THE DISPUTE GIVING RISE TO THE CLAIM



II. A STATEMENT OF THE RELEIF SOUGHT, A SUMMARY OF THE GROUNDS FOR THE CLAIM, AND, IF POSSIBLE, A FINANCIAL ESTIMATE OF THE AMOUNT OF THE CLAIM



III. LANGUAGE OF THE ARBITRATION



IV. SEAT OF THE ARBITRATION



V. APPLICABLE RULES OF LAW


VI. PROOF OF THE DISPATCH TO THE RESPONDENT OF THE REQUEST AND THE ANNEXED

The claimant hereby states that the present request for Arbitration and the annexed documents have been dispatched to the Respondent the (date) by (means of communication). The proof of this dispatch follows below.


(date)



(Claimant)
(name and title)

FOR(Claimant)
Counsel
(First Name, Name)