ARBITRATION FORM

Step 1 of 3

Details of Claimant

Name *

First

Middle

Last

Nationality *

Email *

Phone or Mobile *

Phone or Mobile | Alternative

Fax

P.O. Box

Website / URL

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Claimant Representative

Claimant Representative (If any Legal Representative is available, the POA must be attached along with the Case statement).

Name

First

Middle

Last

Nationality

Phone or Mobile

Phone or Mobile | Alternative

Fax

P.O Box

Website / URL

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

I Request to file an Arbitration case against the Respondent

Name

First

Middle

Last

Nationality

Phone or Mobile

Phone or Mobile | Alternative

Fax

P.O. Box

Website / URL

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Respondent Representative

(if there is any Respondent Representative, the POA must be attached along with the Statement of Claim)

Name

First

Middle

Last

Nationality

Phone or Mobile

Phone or Mobile | Alternative

Fax

P.O Box

Website / URL

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Regarding a dispute against the Respondent

Dispute Details

Summary: Create an option to attach the Statement of Claim along with the documents of arguments.

File Upload

I herby fully authorize IICRA to appoint the Arbitrator to settle the Dispute.

or No, I apologize to mandate IICRA to appoint the Arbitrator (s), thus I hereby nominate an Arbitrator as follows,

Arbitrator Details

Name

First

Middle

Last

Nationality

Phone or Mobile

Phone or Mobile | Alternative

Fax

P.O Box

Website / URL

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Signature

Based on the above, I request IICRA to take all necessary measures to settle the dispute in accordance with IICRA Arbitration Rules, primarily Article No: 11 regarding the Mandatory Law (Sharia Principles).

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