C-26, r. 75 - Regulation respecting the conciliation and arbitration procedure for the accounts of members of the Ordre des conseillers et conseillères d’orientation et des psychoéducateurs et psychoéducatrices du Québec

Schedule Disposition versions

2012-09-01

SCHEDULE III

(ss. 9 and 10)

APPLICATION FOR ARBITRATION OF AN ACCOUNT

I, the undersigned __________(name and address of client)__________, declare under oath that:

(1) __________(name and address of member)__________ is claiming from me (or refuses to refund to me) a sum of money for professional services.

(2) I have attached 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 des conseillers et conseillères d’orientation et des psychoéducateurs et psychoéducatrices du Québec (chapter C-26, r. 75), a copy of which I have received and have taken cognizance.

(4) I agree to abide by the procedure provided for in the Regulation and, where required, to pay to the member concerned the amount of the arbitration award.

And I have signed on __________________________________________________________________

(date)

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(client’s signature)

O.C. 752-2005, Sch. III.