Sample Form

IN THE MATTER OF AN ARBITRATION

PURSUANT TO

(name and date of governing agreement) (the "Agreement")

AND

(governing legislation e.g., Commercial Arbitration Act, R.S.B.C. 1996, c.55)

(the "Act")

TO:

AND TO:

TAKE NOTICE that name of the initiating party (the "Claimant") seeks arbitration of a dispute which has arisen between the Claimant and the Respondent pursuant to (name clause or paragraph of the agreement providing for arbitration or make reference to specific section of legislation or regulation mandating arbitration). A copy of the Agreement is attached with the copy of this Notice to the Centre.

PARTIES TO THE DISPUTE

Claimant

Claimant's solicitor (if applicable)

Address for service:

Phone and Fax (if available)

Respondent

Respondent's Solicitor (if applicable)

Address for Service

Phone and Fax (if available)

I. NATURE OF DISPUTE

The particulars of the dispute are as follows:(Provide a brief outline of the dispute)

II. THE REMEDIES SOUGHT

The Claimant seeks (state the result the Claimant is requesting)

III. VALUE OF THE CLAIM

The value of this claim is estimated at $__________

OR

The value of this claim is unknown at this time or cannot be stated.

IV. NUMBER OF ARBITRATORS

The parties have agreed as follows:

This matter shall be heard by a single arbitrator

OR

This matter shall be heard by an arbitral tribunal of (number if more than one) individuals.

If the parties have not agreed upon the number of arbitrators, the Commercial Arbitration Act and Rules of the Centre require that a single arbitrator be appointed.

V. NAMES OF ARBITRATOR(S)

The parties have not yet agreed to the name of any individual to act as arbitrator

OR

The parties have agreed to the appointment of (name of individual) as sole arbitrator.

OR

The parties have considered, but were unable to agree to the appointment of (names of potential arbitrators considered by the parties).

OR

The claimant appoints (name of individual) as its nominee (i.e., where the parties have agreed to a multi-person tribunal)

VI. QUALIFICATIONS OF THE ARBITRATOR(S)

The parties agree that the single arbitrator be (specific experience, accreditation or knowledge required by the arbitrator as stated in the agreement of the parties)

OR

The Claimant prefers that the single arbitrator be familiar with (specific experience or knowledge required by the arbitrator)

VII. MODIFICATION OF THE RULES OF PROCEDURE FOR DOMESTIC COMMERCIAL ARBITRATIONS

The parties have not agreed to any modification of the rules.

OR

The following modifications have been agreed to by the parties, as set out in (state section of the Agreement or reference and attach other documentation/correspondence in which parties agree to modifications)

VIII. COMMENCEMENT FEE

The commencement fee, in the amount of $______(see current fee schedule) plus GST of $_______, totaling $_____ pursuant to the Fee Schedule as amended November 1, 1997, is attached with the copy of this Notice delivered to the BCICAC.

Date:

______________________

Claimant/Counsel for Claimant