Legal Matter Manager

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claimant
First Name(s)
Surname
Description (i.e. natural person, company, cc, etc)
Address Line 1
Address Line 2
Address Line 3
Postal Code
Cell No
Email Address
VAT Number
claimant representative
Name
Surname
Address Line 1
Address Line 2
Address Line 3
Address Line 4
defendant
First Name(s)
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Description (i.e. natural person, company, cc, etc)
Address Line 1
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defendants representative
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Address Line 4
arbitration
Written Arbitration Agreement
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Statement of Claim and Annexures
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Claim Amount
Preferred Number of Arbitrators
Include AFSA Appeal Procedure in Arbitration?
Requesting a Declaratory Award?
arbitrator
First Name(s)
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Occupation
REQUEST FOR ARBITRATION The Registrar
AFSA Secretariat
First Floor, Grindrod Tower
8A Protea Place, Sandton

PO Box 653007, Benmore, 2010
Docex 143 Randburg
Dear Registrar
On behalf of the undermentioned claimant/s, for whom I have authority to act, I request the Secretariat of the Foundation to accept this request for arbitration under its Rules. Herewith the necessary information:
 
1. CLAIMANT'S DETAILS
Name of Claimant/s: «First Name(s)» «Surname»
Description (i.e. natural person, company, cc, etc.): «Description (i.e. natural person, company, cc, etc)»
Address: «Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
Telephone No: «Cell No»
E-Mail Address: «Email Address»
VAT Number: «VAT Number»
Name and Address of Claimant Legal Representative: «Name» «Surname» of «Address Line 1» «Address Line 2» «Address Line 3» «Address Line 4»
 
2. DEFENDANT'S DETAILS
Name of Defendant/s: «First Name(s)» «Surname»
Description (i.e. natural person, company, cc, etc.): «Description (i.e. natural person, company, cc, etc)»
Address: «Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
elephone No: «Cell No»
E-Mail Address: «Email Address»
VAT Number: «VAT Number»
Name and Address of Defendant Legal Representative: «Name» «Surname» of «Address Line 1» «Address Line 2» «Address Line 3» «Address Line 4»
 
ATTACHMENTS
3.  I attach hereto (delete (i) or (ii) if inapplicable):
  (i) A copy of the Order of Court directing the appointment of an AFSA arbitrator, and/or
  (ii) A copy of the written agreement in which all the parties agree to arbitration; «Written Arbitration Agreement»
     
  and which I have marked "A".  I am satisfied that an award made by the arbitrator in accordance with the claims made by the Claimant (and which form part of the statement attached hereto marked "B") will fall within the terms of the Arbitration Agreement/Court Order.
     
4. I attach hereto a statement marked "B" setting out the Claimant/s right to sue (locus standi); the nature of the dispute the material facts and contentions of the Claimants; the relief claimed and all the documentation relied upon. «Statement of Claim and Annexures»
   
5. I confirm the value of my claim being R«Claim Amount»
** Please send 03 (three) copies of the supporting documents to the Office of the Secretariat **
 
6. ARBITRATOR DETAILS
Fill out 6(i) where the choice of arbitrator has been agreed or made by the Court and 6(ii) and 6(iii) or 6(iv) in all other cases.

(i)          The parties have agreed the identity of an arbitrator/the Court has appointed an arbitrator (delete what is inapplicable) who is -
Name of Arbitrator:  
Address:  
Telephone No.  
E-Mail Address:  
 


 
(ii) The Claimant/s suggests in regard to the selection of an appropriate number of arbitrator/s that:
  The matter should be heard in the first instance by «Preferred Number of Arbitrators» arbitrator/s
(iii) The Claimant/s suggests that the following person/s should be considered for appointment as arbitrator/s:
  (a)  Name/s:  «First Name(s)» «Surname»
  (b)  Address/es: «Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
  (c)  Telephone number/s:  «Tel No (W)»
  (d)  E-Mail address:  «Email Address»
(iv) The Claimant does not wish it to suggest an arbitrator but asks the Registrar to appoint an AFSA arbitrator:
  who is a «Occupation»
 
7. Include AFSA Appeal Procedure in Arbitration?
«Include AFSA Appeal Procedure in Arbitration? | FORMAT.YesNo»
     
8. Requesting a Declaratory Award?
«Requesting a Declaratory Award? | FORMAT.YesNo»
     
9. I attach payment of the first fee in the sum of R1000.00 (One Thousand Rand and Zero Cents) for preliminary processing of the matter and which will be credited against the administration fee payable.  This fee is non-refundable.
   
  
** Please send 03 (three) copies of the supporting documents to the Office of the Secretariat **
    
             

Signature of Claimant/s representative:   _____________________________________


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