APPLICATION FOR ARBITRATION OF ACCOUNT
I, the undersigned, __________(name of client)__________ __________(domicile)__________
Declare that:
(1) __________(name of geologist)__________ is claiming from me (or refuses to reimburse me) a sum of money for professional services.
(2) I have enclosed 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 geologists (chapter G-1.01, r. 4).
(4) I declare that I have received and have taken cognizance of the above-mentioned Regulation.
(5) I agree to abide by the procedure provided for in the Regulation and, where required, to pay to __________(name of geologist)__________ the amount of the arbitration award.
__________________________________________
Signature