C-26, r. 175 - Regulation respecting the conciliation and arbitration procedure for the accounts of members of the Ordre professionnel des inhalothérapeutes du Québec

Schedule Disposition versions

2012-09-01

SCHEDULE I

(ss. 7 and 8)

APPLICATION FOR ARBITRATION OF AN ACCOUNT

I, the undersigned, ___________________________________________________________________________

(client’s name)

---

(domicile)

declare that:

(1) _____________________________________________________________________________________

(member’s name)

is claiming from me (or refuses to reimburse to 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 the accounts of members of the Ordre professionnel des inhalothérapeutes du Québec (chapter C-26, r. 175).

(4) I have received a copy of the Regulation mentioned above and have taken cognizance thereof.

(5) I agree to submit to the procedure provided for in the Regulation and, where required, to pay to

---

(member’s name)

the amount of the arbitration award.

__________________________________________

Signature

O.C. 194-96, Sch. I.