A-33, r. 10 - Regulation respecting the conciliation and arbitration procedure for accounts of members of the Ordre des audioprothésistes du Québec

Schedule Disposition versions

2012-09-01

SCHEDULE I

(ss. 9 and 10)

Application for ACCOUNT arbitration

I, the undersigned, ___________________________________________________________________________

(name of the client)

___________________________________________________________________________

(domicile)

Declare that:

(1) ______________________________________________________________________________________

(name of hearing-aid acoustician)

is claiming from me (or refuses to reimburse me) a sum of money for professional services.

(2) I have enclosed a copy of the conciliation report.

(3) I am applying for arbitration of the account under the Regulation respecting the conciliation and arbitration procedure for accounts of members of the Ordre des audioprothésistes du Québec (chapter A-33, r. 10).

(4) I declare that I have received and have taken cognizance of the above-mentioned Regulation.

(5) I agree to abide by the procedure set out in the Regulation and, where required, to pay to ______________

---

(name of hearing-aid acoustician)

the amount of the arbitration decision.

___________________________________________________________________________

Signature

O.C. 398-2008, Sch. I.