A-12, r. 12 - Regulation respecting the conciliation and arbitration procedure for the accounts of agrologists

Schedule Disposition versions

2012-09-01

SCHEDULE I

(s. 1)

APPLICATION FOR CONCILIATION

I, the undersigned, __________(name and address)__________ personally or (where applicable) representing ______________________________ for the purposes of this application, as attested to by the authorization attached hereto, being duly sworn, declare:

(1) __________(name of agrologist)__________ is claiming from me the sum of __________ for professional services rendered between ______________________________ and ______________________________, as attested to by the account of which a copy is attached hereto;

(2) I am contesting the account for the following reasons:

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but (where applicable) I acknowledge:

(a) owing the sum of $__________ relative to the professional services referred to in the account;

(b) having paid the account or part thereof, in the amount of $__________.

(3) I am applying for conciliation by the syndic under Division I of the Regulation respecting the conciliation and arbitration procedure for the accounts of agrologists (chapter A-12, r. 12), of which I declare having received a copy and taken cognizance.

______________________________

Signature

Oath taken before __________(name and position, profession or quality)__________ in __________(municipality)__________, on __________(date)__________

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Signature

O.C. 1068-95, Sch. I.