Here you can download the declaration of independence

CEPANI SECRETARIAT
RUE DES SOLS, 8
B-1000 BRUSSELS
-----------------------------------


Arbitration n¢X

DECLARATION OF INDEPENDENCE OF THE INDEPENDENT THIRD PARTY

The undersigned,

Name :..............................................................First name : ...................................................


? declare that I shall abide by the "Rules of good conduct for procedures requiring the intervention of CEPANI¨ enclosed as Annex II to the CEPANI Arbitration Rules.

? declare that I am fully independent of:

? the parties
? their legal counsel

? draw CEPANI's attention to the following facts and circumstances that could lead any of the parties to doubt my independence (use a separate sheet if necessary).

Done in.............................., the ........................................

Signature :

Name:

* Please check of the appropriate box.