	REQUEST FOR ARBITRATION	The Registrar AFSA Secretariat First Floor, Grindrod Tower 8A Protea Place, Sandton PO Box 653007, Benmore, 2010 Docex 143 Randburg

Dear Registrar

On behalf of the undermentioned claimant/s, for whom I have authority to act, I request the Secretariat of the Foundation to accept this request for arbitration under its Rules. Herewith the necessary information:

1. PARTIES

1(a)	Name of Claimant/s (In the case of multiple Claimants this information is to be provided for each Claimant)

«First Name(s)» «Surname»

(b)	Nationality of Claimant or country in which it conducts business:

«Nationality»

(c)	Telephone No.:

«Telephone No. (W)»

(d)	E-Mail Address:

«Email Address»

(e)	Name of Claimant's legal representative:

«Representative Name & Surname» of «Organisation Name»

2(a)	Name of Respondent (In the case of multiple Respondents this information is to be provided for each Respondent):

«First Name(s)» «Surname»

(b)	Nationality of Respondent or country in which it conducts business:

«Nationality»

(c)	Telephone No.:

«Telephone No. (W)»

(d)	E-Mail Address:

«Email Address»

(e)	Name of Respondent's legal representative if known:

«Representative Name & Surname» of «Organisation»

2. ARBITRATION AGREEMENT

(i)	A copy of the written arbitration agreement in which all the parties agree to arbitration and which I have marked ''A'' «Written Arbitration Agreement(s)»
(ii)	I am satisfied that an award made by the tribunal in accordance with the claims made by the Claimant (and which form part of the statement attached hereto marked "B") will fall within the terms of the Arbitration Agreement/Court Order.

3. STATEMENT OF CLAIM

I attach hereto a statement marked "B" setting out the Claimant/s right to sue (locus standi); the nature of the dispute the material facts and contentions of the Claimants; the relief claimed and all the documentation relied upon «Statement of Claim & Annexures (if required)»

4. LANGUAGE REQUIREMENTS

(i)	Home Language of Claimant/s

«Claimant Home Language»

5. REGISTRATION FEE

I attach payment of the registration fee in the sum of R1150.00 (One Thousand One Hundred and Fifty Rand and Zero Cents), inclusive of 15% VAT, for preliminary processing of the matter and which will be credited against the administration fee payable. This fee is non-refundable

** Please send 03 (three) copies of the supporting documents to the Office of the Secretariat **

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