AGREEMENT RESPECTING A DISPUTE
SUBMITTED TO CONCILIATION □
OR
TO ARBITRATION □
Entered into between:
(name and address of client)
hereinafter referred to as “the client”,
and
(name and address of member)
who state and agree as follows:
An agreement has been entered into between the client and the member concerning the dispute submitted to conciliation □
or
to arbitration □
applied for on __________(date)__________
The agreement provides for the following terms and conditions:
The client and the member request that the
conciliation □
or
arbitration □
proceedings be stayed.
(client’s signature)
Signed at ____________________________________________________________________________
(place)
on __________________________________________________________________________________
(date)
(member’s signature)
Signed at ____________________________________________________________________________
(place)
on __________________________________________________________________________________
(date)