Arbitration n°. (reference number given by the CEPANI)
TERMS OF REFERENCE
In the arbitration in accordance with the rules of CEPANI
BETWEEN
(Claimant)
AND
(Respondent)
I.NAMES AND ADDRESSES OF THE PARTIES AND THEIR COUNSELS
I.1.Claimant
(Description)
(Person to contact)
(Address)
Tel:
Fax:
E-mail:
Counsel:(First name, NAME)
(Title)
(Office address)
Tel:
Fax:
E-mail:
I.2.Respondent
(Description)
(Person to contact)
(Address)
Tel:
Fax:
E-mail:
Counsel:(First name, NAME)
(Title)
(Office address)
Tel:
Fax:
E-mail:
II.COORDINATES OF THE ARBITRAL TRIBUNALAND THE ACCEPTANCE OF THE NOMINATION
In the arbitration mentioned above, the Appointments Committee or the Chairman ofCEPANI appoints in accordance with article 15 ofCEPANI rules, the following arbitral tribunal:
Chairman/Sole Arbitrator
(First Name, NAME)
(Title)
(Office address)
Tel:
Fax:
E-mail:
Co-arbitrator proposed by Claimant
(First Name, NAME)
(Title)
(Office address)
Tel:
Fax:
E-mail:
Co-arbitrator proposed byRespondent
(First Name, NAME)
(Title)
(Office address)
Tel:
Fax:
E-mail:
By signing the Terms of Reference, each party adheres to the fact that the arbitral tribunal has been appointed following the rules in force and that they have no comments in regards to the appointment as from the signature of the terms of reference.
III.COMMUNICATION ANDINFORMATION
Anycommunication and information between the arbitral Tribunal and the parties and conversely must be sent at the same time and in the same way to the other parties concerned and to the Secretariat of CEPANI.
Any communication and information in regards to the arbitration, in accordance with the Rules of CEPANI must be sent to the following address:
For the Claimant:
For the Respondent:
For the Arbitral Tribunal:
For the Secretariat of the CEPANI:CEPANInpo
Secretariat
Rue des Sols 8
1000 BRUSSELS
Tel.: +32 (0)2 515 08 35
Fax: + 32 (0)2 515 08 75
E-mail:
IV.SUMMARY STATEMENT OF THE PARTIES CONCERNED
V.SUMMARY OF THE CLAIM AND THE POSITION OF THE CLAIMANT
VI.SUMMARY OF THE CLAIM AND POSITION OF THE RESPONDENT
VII.ISSUES IN DISPUTE
IIX.SEAT OF THE ARBITRATION
The seat of the Arbitration is (city).
IX.LANGUAGE OF THE PROCEEDINGS
The language of the arbitration will be (language) and in accordance with the rules of CEPANI in force as in from the 1st of January 2013.
* * *
Done in (seat of the arbitration), (date)
In (number) copies, each party acknowledging it has received its copy.
FOR (Claimant)FOR (Respondent)
(name + title)(name + title)
FOR (Claimant)FOR (Claimant)
CounselCounsel
(Name, First name)(Name, First name)
THE ARBITRAL TRIBUNAL
(Name, First name)
Chairman/ Sole Arbitrator
(Name, First Name)(Name, First Name)
ArbitratorArbitrator