APPLICATION FOR CONCILIATION
I, the undersigned, __________(name and address)__________ in person or (where applicable) representing ______________________________ for the purposes of this application, as attested to by the authorization annexed hereto, being duly sworn, declare:
(1) __________(name of forest engineer)__________ claims from me the sum of ______________________________ for professional services rendered between ______________________________ and ______________________________ as attested to by the account a copy of which is annexed hereto;
(2) I refuse to pay this account for the following reason(s):
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 forest engineers (chapter I-10, r. 10), of which I declare having received a copy and taken cognizance.
Sworn to before me
at ____________________________________ this _____________________________________ 20__________
And I have signed
(signature of client or his duly authorized representative)
(Commissioner for oaths)