C-26, r. 88 - Regulation respecting the procedure for conciliation and arbitration of accounts of certified human resource and industrial relations counsellors

Schedule Disposition versions

2012-09-01

SCHEDULE 1

(s. 2.02)

APPLICATION FOR CONCILIATION

I, the undersigned, ___________________________________________________________________________

(name and address)

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in person or (where applicable) representing ___________________________________ for the purposes of this application, as attested by the authorization annexed hereto, being duly sworn, declare that:

(1) _______________________________________________________________________________ claims

(name of counsellor)

from me the sum of _________________ for professional services rendered between ______________________ and ______________________________, as attested by the account a copy of which is annexed hereto;

(2) I refuse to pay this account for the following reason(s):

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but (where applicable) I acknowledge that I owe the sum of _________________ for the professional services referred to in such account;

(3) I apply for conciliation by the syndic pursuant to Division II of the Regulation respecting the procedure for conciliation and arbitration of accounts of certified human resource and industrial relations counsellors (chapter C-26, r. 88) of which I declare having received a copy and taken cognizance.

And I have signed

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(signature of client or his duly authorized representative)

Sworn before me

at ________________________________________________________________________________________

this ______________________________________________________________________________ 20______

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Commissioner for oaths

R.R.Q., 1981, c. C-26, r. 57, Sch. 1.