O-7, r. 16 - Regulation respecting the conciliation and arbitration procedure for the accounts of members of the Ordre des optométristes du Québec

Annexe Versions de la disposition

2012-09-01

SCHEDULE I

(s. 8)

APPLICATION FOR ARBITRATION OF AN ACCOUNT

I, the undersigned, __________(client’s name)__________ __________(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 conciliation and arbitration procedure for the accounts of members of the Ordre des optométristes du Québec (chapter O-7, r. 16).

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 the Regulation and, where required, to pay to __________(member’s name)__________ the amount of the arbitration award.

_____________________________________________

(signature)

O.C. 1364-94, Sch. I.