Request for Arbitration

Claimant：____________

Address：____________

E-mail：____________

Tel：____________

Fax：____________

Legal Representative：______

Position：____________

Agent：______、______

Agent’s Contact Information： ____________

（hint：If there are more than one Claimant，please list as Claimant A、Claimant B）

Respondent：____________

Address：____________

E-mail：____________

Tel：____________

FAX：____________

Legal Representative：______

Position：____________

Agent：______、______

Agent’s Contact Information： ____________

（hint：If there are more than one Respondent，please list as Respondent A、Respondent B）

Arbitration Agreement：

Claims：

1.

2.

……

The facts and grounds：

……

To

（Arbitral Institution）

Claimant：×××（seal）

Legal Representative：______（signature）

Date: