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Global Arbitration And Mediation Service (GAMS) Provides Fair, Just, Simple, Quick And Effective Dispute Resolution

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Global Arbitration and Mediation Service

NOTICE OF REQUEST FOR ARBITRATION

To Respondents: demand. for arbitration of the specified dispute between you is hereby made by the below named Claimant (s) . Claimant (s) further demand that said arbitration be administered by Global Arbitration and Mediation Service (“GAMS”) according to its arbitration rules effective on the date of filing this demand. FAILURE TO RESPOND TO THIS DEMAND MAY RESULT IN AN AWARD BEING RENDERED AGAINST YOU AND CONFIRMATION OF THAT AWARD AS A LEGAL JUDGMENT AGAINST YOU BY A COURT OF COMPETENT JURISDICTION.

CLAIMANT INFORMATION
[Please type or print legibly]

NAME:__________________________________ COMPANY_________________________________

ADDRESS:________________________________________________________________________

CITY:__________________________________STATE_______________ ZIP CODE______________

COUNTRY:___________________________________________________

TELEPHONE:____________________________FAX:_____________________________

EMAIL:_________________________

I Wish to represent myself I will have a representative

CLAIMANT�S REPRESENTATIVE

NAME:__________________________________ COMPANY________________________________

ADDRESS:________________________________________________________________________

CITY:______________________________STATE________________ ZIP CODE________________

COUNTRY:______________________________________________________

TELEPHONE:____________________________ FAX:__________________________

EMAIL:___________________________

Additional Claimant Information Attached

RESPONDENTS INFORMATION

NAME:___________________________________ COMPANY________________________________

ADDRESS:________________________________________________________________________

CITY:__________________________________STATE______________ ZIP CODE_____________

COUNTRY:________________________________________________________

TELEPHONE:______________________________FAX:____________________________

EMAIL:______________________________________


RESPONDENTS INFORMATION

NAME:___________________________________ COMPANY________________________________

ADDRESS:________________________________________________________________________

CITY:__________________________________STATE______________ ZIP CODE_____________

COUNTRY:__________________________________________________________

TELEPHONE:______________________________FAX:____________________________

EMAIL:______________________________________


NATURE OF CLAIM (attach copies of the arbitration agreement to this notice):

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

RELIEF REQUESTED (Specify the amount in controversy and all claims for relief):_________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________


LOCATION REQUESTED FOR HEARING:_______________________________________________

Any objection to this arbitration or to the administration of the arbitration of the dispute described herein by GAMS must be filed with GAMS within 7 days or is deemed waived. By signing this I agree to submit the above specified dispute to binding arbitration administered by GAMS and agree to comply with all GAMS Arbitration Rules, policies and rulings. Persons signing this document on behalf of an entity warrant their authority to bind that entity.

DATE:_________________

SIGNED (CLAIMANT)________________________________________________________

TITLE:____________________________________________________________________

COMPANY:________________________________________________________________

At _______________________________________________________________________.
(City and State where signed)

ADDITIONAL CLAIMANT INFORMATION

NAME:_____________________________ COMPANY_____________________________

ADDRESS:________________________________________

CITY:____________________ STATE____________ ZIP CODE_____________

COUNTRY:____________________________

TELEPHONE:________________________ FAX:________________________

EMAIL:_______________________

I wish to represent myself I will have an representative


CLAIMANT�S REPRESENTATIVE

NAME:_____________________________ COMPANY_____________________________

ADDRESS:___________________________________________________________________

CITY:____________________STATE_______________ ZIP CODE____________

COUNTRY:_____________________________________________

TELEPHONE:________________________ FAX:________________________

EMAIL:_______________________________

This form should be reproduced to name additional claimants.

ADDITIONAL RESPONDENTS INFORMATION

NAME:______________________________ COMPANY_____________________________

ADDRESS:________________________________________________________________

CITY:____________________ STATE____________ ZIP CODE_____________

COUNTRY:__________________________________________

TELEPHONE:________________________ FAX:__________________________

EMAIL:____________________________


NAME:______________________________ COMPANY_____________________________

ADDRESS:________________________________________________________________

CITY:__________________________ STATE____________ ZIP CODE_____________

COUNTRY:_____________________________________________

TELEPHONE:________________________ FAX:____________________________

EMAIL:_________________________________

This form should be reproduced to name additional respondents.

INSTRUCTIONS FOR USE

1. Fill out this form by typing or printing clearly in ink.
2. Attach copies of the contract between the parties which contains the arbitration clause or Post Dispute Arbitration Agreement.
3. File the original Notice of Request for Arbitration and attachments along with the appropriate filing fee with GAMS.
4. The assigned Case Administrator will contact you to begin the arbitration process.




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