| Request for Arbitration |
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REQUEST FOR ARBITRATION
CEPANI npo (Claimant: Hereinafter the "Claimant"
(having as Counsel) Hereinafter the « Respondent »
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With all proper reserves and without any prejudicial recognition
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
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)
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