Legal Matter Manager

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claimant
First Name(s)
Surname
Description (i.e. natural person, company, cc, etc)
Nationality
Address Line 1
Address Line 2
Address Line 3
Postal Code
Cell No
Email Address
VAT Number
Claimant Home Language
Other language in which Claimant is proficient
claimant representative
Organisation Name
Address Line 1
Address Line 2
Address Line 3
Postal Code
defendant
First Name(s)
Surname
Description (i.e. natural person, company, cc, etc)
Nationality
Address Line 1
Address Line 2
Address Line 3
Postal Code
Cell Number
Email Address
VAT Number
defendants representative
Organisation Name
Address Line 1
Address Line 2
Address Line 3
Postal Code
arbitration
Written Arbitration Agreement
Display as tickbox
Statement of Claim & Annexures
Display as tickbox
Preferred Language for Arbitrator Proceedings
If Other Language Preferred, please specify
Does the Arbitration agreement identify a Venue/Seat?
If so, what is the Venue/Seat?
If not, does the Claimant have any preferences as to Venue/Seat?
Agreement Identifies Proper Law?
If so, what is the proper law applicable?
Preferred Number of Arbitrators
Other Matters Secretariat Must Consider?
Include AFSA Appeal Process?
Requesting a Declaratory Award?
arbitrator
First Name(s)
Surname
Address Line 1
Address Line 2
Address Line 3
Postal Code
Tel No (W)
Email Address
Qualifications
Nationality
State any particular qualifications that the Secretariat should consider in appointing a Chairman of the tribunal
Surname
REQUEST FOR ARBITRATION The Registrar
AFSA Secretariat
First Floor, Grindrod Tower
8A Protea Place, Sandton

PO Box 653007, Benmore, 2010
Docex 143 Randburg
 
Dear Secretariat
On behalf of the undermentioned claimant/s, for whom I have authority to act, I request the Secretariat of AFSA International to accept
this request for arbitration under its Rules. Herewith the necessary information:

 
PARTIES
   
1(a) Name of Claimant/s (In the case of multiple Claimants this information is to be provided for each Claimant)
«First Name(s)» «Surname»
  (b) Description (i.e. natural person, company, cc, etc.)
«Description (i.e. natural person, company, cc, etc)»
  (c) Nationality of Claimant or country in which it conducts business:
«Nationality»
  (d) Address:
«Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
  (e) Telephone No.
«Cell No»
  (f) E-Mail Address:
«Email Address»
  (g) VAT Number
«VAT Number»
  (h) Name and address of Claimant's legal representative:
«Organisation Name» of «Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
 
   
2(a) Name of Respondent (In the case of multiple Respondents this information is to be provided for each Respondent):
«First Name(s)»  «Surname»
  (b) Description (i.e. natural person, company, cc, etc.)
«Description (i.e. natural person, company, cc, etc)»
  (c) Nationality of Respondent or country in which it conducts business:
«Nationality»
  (d) Address:
«Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
  (e) Telephone No.
«Cell Number»
  (f) E-Mail Address:
«Email Address»
  (g) VAT Number
«VAT Number»
  (h) Name and address of Respondent's legal representative if known:
«Organisation Name» of  «Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
 
3. ARBITRATION AGREEMENT
  (i) A copy of the written arbitration agreement  in which all the parties agree to arbitration and which I have marked ''A''  «Written Arbitration Agreement»
  (ii) I am satisfied that an award made by the tribunal 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. STATEMENT OF CLAIM
  (i) A copy of the written arbitration agreement  in which all the parties agree to arbitration and which I have marked “A”   «Statement of Claim & Annexures»
  (ii) I am satisfied that an award made by the tribunal 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.
 



 
5. LANGUAGE REQUIREMENTS
   
(i) Home Language of Claimant/s
«Claimant Home Language»
(ii) Other languages in which Claimant/s is/are proficient
«Other language in which Claimant is proficient»
(iii) Preferred language for the arbitration proceedings:
«Preferred Language for Arbitrator Proceedings» «If Other Language Preferred, please specify»
(iv) Is it envisaged that a translation service will be required?
 
 
6. VENUE AND SEAT
   
(i) Does the arbitration agreement identify a venue and/or seat?
«Does the Arbitration agreement identify a Venue/Seat?»
(ii) If so, what is the venue and/or seat?
«If so, what is the Venue/Seat?»
(iii) If not, does/do the Claimant/s have any preferences as to venue and/or seat?
«If not, does the Claimant have any preferences as to Venue/Seat?»
 
7. PROPER LAW
   
(i) Does the arbitration agreement identify the proper law (is the law applicable to the merits of the dispute)?
«Agreement Identifies Proper Law?»
(ii) If so, what is the venue and/or seat? If so, what is the proper law applicable?
«If so, what is the proper law applicable?»
(iii) If not, does/do the Claimant/s have any preferences as to enue and/or seat?
«If not, does Claimant have any proposals regarding choice of the proper law?»
 
8. CHOICE OF TRIBUNAL
   
a(i) Does the arbitration agreement identify the number of arbitrators who must constitute the Panel?
 (ii) If so, what is the required number?
«Preferred Number of Arbitrators»
 (iii) If not, what recommendation does/do the Claimant/s make regarding the number of members of the tribunal?
«If not, does Claimant have any proposals regarding choice of the proper law?»
 
   
b(i) Does the arbitration agreement name the arbitrator/s who are to be  members of the tribunal?
 (ii) If so, please provide the name, address, telephone number, facsimile number and email address of each named arbitrator?
  Name:
  Address:
 
  Telephone No.
 
  E-Mail Address:
 
   
c. If the Arbitration Agreement does not identify the arbitrators and if the Secretariat directs, after consultation with the parties, that the tribunal should consist of three persons, one nominated by the Claimant or Claimants jointly, one nominated by the Respondent, or the Respondents jointly, and a Chairman selected by the Secretariat, then:
(i) Please provide the name of the Claimant’s nomination of an arbitrator with full details of such nominee, including the nominee’s full name, address, professional qualifications, telephone number, facsimile number, email address and nationality;
  Name:
«First Name(s)» «Surname»
  Address:
«Address Line 1» «Address Line 2» «Address Line 3» «Postal Code»
  Telephone No.
«Tel No (W)»
  E-mail:
«Email Address»
  Qualifications:
«Qualifications»
  Nationality:
«Nationality»
(ii) If the Claimant wishes to suggest any particular qualifications that the Secretariat should consider in appointing a Chairman of the tribunal, then list such qualifications.
«State any particular qualifications that the Secretariat should consider in appointing a Chairman of the tribunal»
 
d. In the event that the Panel is to consist of one arbitrator only, please indicate any particular qualifications and  requirements which the Secretariat should consider in making such appointment.
 
9. MISCELLANOUS
Are there any other matters to which the Claimant would wish the Secretariat to take into consideration in administering the matter? If so, please state:  «Other Matters Secretariat Must Consider?»
Include AFSA Appeal Process? «Include AFSA Appeal Process?»
Requesting a Declaratory Award? «Requesting a Declaratory Award?»
 
10. ADMINISTRATION FEE
I attach payment of the first fee in the sum of R__________________ for preliminary processing of the matter and which will be credited against the administration fee payable.  This fee is non-refundable.  Furthermore, Claimant acknowledges that if the Secretariat accepts this request for arbitration under its Rules, then Claimant's share of the administration fee will fall due for payment within 14 days of the Secretariat's fee invoice.
 
** Please send 03 (three) copies of the supporting documents to the Office of the Secretariat **



_______________________________________
Signature of Claimant/s representative


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