APPLICATION FOR ARBITRATION OF AN ACCOUNT
I, the undersigned, __________(surname)__________ __________(name)__________ __________(address)__________ __________(occupation)__________
declare that:
(1) On ______________, ________________ sent an account of $__________ for professional services to __________(name of client applying for arbitration)__________
(2) Check a or b:
(a) I am the client applying for arbitration;
(b) I am the mandatary of the client applying for arbitration and I am duly authorized, by virtue of an authorization attached hereto, to sign these presents, in the client’s name.
(3) Check a or b and state reasons:
(a) I refuse to pay the account;
(b) I request reimbursement in the amount of $__________
Reasons:
(4) During conciliation, I acknowledged owing the amount of $__________ and am therefore filing, with this application, a certified cheque for that amount payable to the executive director of the Barreau du Québec “in trust”.
(5) I agree to submit to the procedure provided for in the Regulation respecting the conciliation and arbitration procedure for the accounts of advocates (chapter B-1, r. 17) and to the resulting arbitration award.
(6) I hereby waive the benefit of any time elapsed with respect to prescription.
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Date
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Signature