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Dominion of Melchizedek
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Have you requested a court reporter to be present for the binding arbitration? [Yes___, No____; further, we have mutually agreed to a court reporter being present during the binding arbitration proceedings, and we have mutually made arrangements for same Yes___; No____]. Provision for any direct payment of court reporter services must be made by the parties, with the cost divided according to your mutual agreement. The DOMPCA does not provide for court reporter services, nor the recording of mediation or arbitration proceedings. If Mediation, One Mediator Will be appointed pursuant to the Mediation Rules. If Arbitration, please mutually indicate by an "X" the number of Arbitrators requested by you. One[__] or Three[__]
We agree that, if binding arbitration is selected and indicated above, we will abide by and perform any award rendered hereunder and that a judgment may be entered on the award. _____________________________________ ____________________________________
Name of Party Name of Party
_____________________________________ ____________________________________
Address Address
_____________________________________ ____________________________________
City, State County, Postal Code City, State Country, Postal Code
( ) __________ ( ) ______________ ( ) __________ ( ) _____________
Telephone Fax Telephone Fax
_____________________________________ ____________________________________
Signature† Signature†
_____________________________________ ____________________________________
Name of Representative for Party Name of Representative for Party
_____________________________________ ____________________________________
Name of Firm (if Applicable) Name of Firm (if Applicable)
_____________________________________ ____________________________________
Representative's Address Representative's Address
_____________________________________ ____________________________________
City, State, Country, Postal Code City, State, Country, Postal Code
( ) __________ ( ) ______________ ( ) __________ ( ) _____________
Telephone Fax Telephone Fax
_____________________________________ ____________________________________
Signature† Signature†
- 2 - Expedited Processing and Hearing: Although the DOMPCA does not ordinarily provide expedited mediation or arbitration services, pending availiability of a mediator or arbitrator, and upon a showing in letter form of an exceptional urgency under Article 9 of the DOMPCA Arbitration Rules, copied to all parties under Article 9.2, under Article 9.3, the express time-limits set out in the Arbitrations Rules may be abridged and shortened for good cause shown. Accordingly, ________________________ [party name] hereby requests expedited formation of an arbitration tribunal under Article 9 of the DOMPCA Arbitration Rules. A copy of this SUBMISSION TO DISPUTE RESOLUTION form has been sent with all attachments hereto to the other party(ies) by [___] post mailed______________, and/or [___] overnight courier, delivered to the courier on_________________, and/or [___] telecopier sent __________________. All parties have [___] have not [___] agreed to expedited mediation [___] and/or arbitration [___] All parties [___] have [___] have not agreed to the date for the expedited hearing. If applicable, the agreed date we have requested for the hearing is: Mediation: Date Agreed and Now Requested: ____________________ Time: From _____ to _____ Total Time Estimate of Claimant: Specify days___ hours___ for the mediation Total Time Estimate of Respondent: Specify days___ hours___ for the mediation Arbitration: Date Agreed and Now Requested: ____________________ Time: From _____ to _____ Total Time Estimate of Claimant: Specify days___ hours___ for the arbitration Total Time Estimate of Respondent: Specify days___ hours___ for the arbitration Please file three original copies with the DOMPCA, or if by telecopier one
legible copy from which copies will be made - 3 -
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