APPLICATION FOR ARBITRATION OF AN ACCOUNT
I, the undersigned, __________(name of the person seeking arbitration)__________ __________(domicile)__________ declare that:
(1) __________(member’s name)__________ is claiming from me (or refuses to reimburse to 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 procedure for conciliation and arbitration of accounts of engineers (chapter I-9, r. 11).
(4) I have received a copy of the Regulation mentioned above and have taken cognizance thereof.
(5) I agree to submit to the procedure provided for in that Regulation and, where required, to pay to __________(member’s name)__________ the amount of the arbitration award.
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Signature