International Arbitration Request Form

Request for International Arbitration

IN THE MATTER OF AN ARBITRATION UNDER THE AFSA INTERNATIONAL ARBITRATION RULES (2021)

Claimant Information

Full Legal Name of Claimant(Required)

In case of multiple Claimants, this information is to be provided for each Claimant

Description of Claimant(Required)

Natural person, company, etc. In the case of a company, specify under which laws it is registered (i.e., country/jurisdiction)

Nationality(Required)

Please Select.

Contact Person(Required)

Name of Claimant’s director and/or contact.

Physical Address (In the case of a company - provide a registered office)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number(Required)

Email address(Required)

Claimant Representatives Information

Name of Legal Representative(Required)

Law firm or counsel

Contact Person(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number(Required)

Email Address(Required)

Respondent Information

Full Legal Name of Respondent(Required)

In case of multiple Respondents, this information is to be provided for each Respondent

Description of Respondent(Required)

Natural person, company, etc. In the case of a company, specify under which laws it is registered (i.e., country/jurisdiction)

Nationality(Required)

Please Select.

Contact Person(Required)

Physical Address (In the case of a company - provide a registered office)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number(Required)

Email Address(Required)

Respondent Representatives Information

Name of Legal Representative(Required)

Contact Person(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number(Required)

Email Address(Required)

Agreement

Type Agreement Upon Which the Request is Based(Required)

Date of Agreement(Required)

Arbitration Agreement/Clause (AFSA Jurisdiction)(Required)

Seat/Place of Arbitration(if agreed) or Indicate if not Specified (City, Country)(Required)

The Arbitration Agreement does not specify the seat of the arbitration. Claimant proposes that the seat of the arbitration be(Required)

Applicable Law(Required)

Language of Arbitration(Required)

Applicable AFSA Rules(Required)

Tribunal Composition

Number of Arbitrators Agreed upon (one or three)(Required)

Insert provision of Arbitration Agreement - provides for a three-member Arbitral Tribunal/sole arbitrator

Arbitrator/ Co-Arbitrator Qualifications(Required)

The Claimant further requests that the Arbitrator /Co-Arbitrator be proficient in(Required)

Please Specify(Required)

The Appointment Procedure(Required)

Indicate Any Particular Additional Requirements that the AFSA Court Should Consider in Making Such an Appointment(Required)

Claimant Nominates the Following Arbitrator Candidate for Appointment(Required)

Arbitrator’s Candidate Nationality(Required)

Arbitrator’s Candidate Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Arbitrator’s Candidate Telephone Number(Required)

Arbitrator’s Candidate Email Address(Required)

Description of the Dispute

Quantum in Dispute(Required)

Currency(Required)

A Brief Description of the Dispute and the Claims Being Advanced(Required)

Insert a summary of the dispute. Describe: (a) the Parties’ contractual relationship; (b) the nature and circumstances of the dispute giving rise to the Claimant’s claim including legal bases for such claims and the relevant facts supporting them; (c) estimated monetary value of the claim; and (d) the relief sought by the Claimant against any other party to the arbitration.

The Estimated Monetary Value of the Claim(s) (if applicable)

Preliminary Statement of the Relief Requested(Required)

The Relief or Remedy Sought (e.g., Damages, Declaration, Specific Performance)(Required)

Supporting Documents

Upload the following files (PDF preferred): (1.) The Request for Arbitration (if prepared as a separate document) (2) The contract and any relevant correspondence (3.) Proof of payment of the registration fee (4.) Sufficient proof of delivery of the Request for Arbitration and supporting documentation.

Upload Supporting Documents(Required)

Drop files here or

Max. file size: 128 MB, Max. files: 5.

Request for International Arbitration

Claimant Information

Claimant Representatives Information

Respondent Information

Respondent Representatives Information

Agreement

Tribunal Composition

Description of the Dispute

Supporting Documents

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