H-4.1, r. 12 - Regulation respecting the conciliation and arbitration procedure for the accounts of court bailiffs

Schedule Disposition versions

2012-09-01

SCHEDULE II

(ss. 13 and 16)

APPLICATION FOR ARBITRATION

I, the undersigned, declare the following:

Identification of applicant

IF APPLICABLE,

represented by:

__________________________________________ ____________________________________________

Name of applicant Name of attorney

__________________________________________ ____________________________________________

Number Street Apartment Number Street

__________________________________________ ____________________________________________

Town or city Province Postal Code Town or city Province Postal Code

__________________________________________ ____________________________________________

Tel. (office) Fax Tel. Fax

__________________________________________

Tel. (domicile)

Identification of bailiff

__________________________________________

Name of bailiff

__________________________________________

Number Street

__________________________________________

Town or city Province Postal Code

__________________________________________

Tel. Fax

(Fill in one of the following 3 boxes: Fees paid in full; Fees paid in part; or Fees unpaid. In the box selected, fill in Part 1 that applies to your situation and Part 2.)

Fees paid in full

(1) On __________(date of receipt of account)__________, I received an account for bailiff fees in the amount of

$__________ for professional services rendered, a copy of which is attached hereto.

OR

(1) On __________(date)__________, I became aware that the amount of $__________

had been deducted as payment of the bailiff fees from the funds held in trust on my behalf by the bailiff.

(Check and fill in, if applicable)

□ I received the account for bailiff fees on ______________________________.

□ To date, I have received no account for bailiff fees.

(2) Since the account has been paid, I hereby request a refund of $___________, considering that the amount of $__________ constitutes a just and reasonable fee for the professional services rendered.

Fees paid in part

(1) On __________(date of receipt of account)__________, I received an account for bailiff fees in the amount of $__________ for professional services rendered, a copy of which is attached hereto.

OR

(1) On __________(date)__________, I became aware that the amount of $__________ had been deducted as payment of the bailiff fees from the funds held in trust on my behalf by the bailiff.

(Check and fill in, if applicable)

□ I received the account for bailiff fees on ______________________________.

□ To date, I have received no account for bailiff fees.

(2) Since the account has been paid in part, I acknowledge owing $__________ considering that the amount of $__________ constitutes a just and reasonable fee for the professional services rendered.

Fees unpaid

(1) On __________(date of receipt of account)__________, I received an account for bailiff fees in the amount of $__________ for professional services rendered, a copy of which is attached hereto.

OR

(1) To date, I have received no account for bailiff fees detailing the professional services rendered.

(2) Since the account has not been paid, I acknowledge owing the amount of $__________ that constitutes a just and reasonable fee for the professional services rendered.

(3) Reasons for the application for arbitration: ___________________________________________________

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(An explanatory letter may be attached if additional space is required.)

For prescription purposes, I hereby waive my benefit with respect to time elapsed.

The application for arbitration was filed because the conciliation procedure did not lead to an agreement between the parties as attested to by the copy of the conciliation report I have enclosed in this application.

Object of the dispute

The amount of $__________, which represents the difference between the account and the amount of $__________ that I acknowledge as constituting a just and reasonable fee for the professional services rendered.

I hereby request that the dispute be settled by arbitration held in accordance with the Regulation respecting the conciliation and arbitration procedure for the accounts of bailiffs (chapter H-4.1, r. 12), a copy of which I declare having received and taken cognizance of.

I hereby agree to comply with the decision of the council of arbitration that will be formed in accordance with this Regulation.

Signed at ___________________________________________________________________________________

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(Signature of applicant or applicant’s attorney)

O.C. 1468-2002, Sch. II.