APPLICATION FOR ARBITRATION OF AN ACCOUNT
I, the undersigned, __________(client’s name)__________ __________(domicile)__________ swear under oath 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, if such exists.
(3) I am applying for arbitration of the account under the Regulation respecting the conciliation and arbitration procedure for the accounts of members of the Ordre des arpenteurs-géomètres du Québec (chapter A-23, r. 13).
(4) I have enclosed a certified cheque for the amount I acknowledge owing to __________(member’s name)__________
(5) I have received a copy of the Regulation mentioned above and have taken cognizance thereof.
(6) I agree to submit to the procedure provided for in the Regulation and, where required, to pay to __________(member’s name)__________ the amount of the arbitration decision, which is without appeal and is binding on the parties.
Sworn BEFORE ME AT ____________________ ON _________________ 20____