Here you can download the model for the request for arbitration

REQUEST FOR ARBITRATION

CEPANI npo
Belgian Centre for arbitration and mediation
Rue des Sols 8
1000 Brussels

(Claimant:
name, first name and name in full, description, address, telephone and fax numbers, e-mail address and VAT number)
having as counsel:

Hereinafter the "Claimant"

presents to CEPANI and following the Rules of CEPANI, as from the introduction of the request to the resolution of the dispute between him and:

(The Respondent:
name, first name and name in full, description, address, telephone and fax numbers, e-mail address and VAT number)

(having as Counsel)

Hereinafter the « Respondent »

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Considering the CEPANI Rules in force as from the 1st of January 2013

With all proper reserves and without any prejudicial recognition

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The Request for arbitration is based on the following facts :

I. A RECITAL OF THE NATURE AND CIRCUMSTANCES OF THE DISPUTE GIVING RISE TO THE CLAIM

II. A STATEMENT OF THE RELEIF SOUGHT, A SUMMARY OF THE GROUNDS FOR THE CLAIM, AND, IF POSSIBLE, A FINANCIAL ESTIMATE OF THE AMOUNT OF THE CLAIM

III. INFORMATION CONCERNING THE NUMBER OF ARBITRATORS

(number of arbitrators in accordance with the Arbitration clause and the possible proposal of a co-arbitrator with the mention of his name, address, telephone and fax numbers)

IV. LANGUAGE OF THE ARBITRATION

V. SEAT OF THE ARBITRATION

VI. APPLICABLE RULES OF LAW

V. PROOF OF THE DISPATCH TO THE RESPONDENT OF THE REQUEST AND THE ANNEXED

The claimant hereby states that the present request for Arbitration and the annexed documents have been dispatched to the Respondent the (date) by (means of communication). The proof of this dispatch follows below.

(date)

(Claimant) FOR(Claimant)
(name and title) Counsel
(First Name, Name)