FORM XVII

(See Section 64 and Rule 45)

APPLICATION FOR REFERENCE OF A DISPUTE TO ARBITRATION BEFORE THE REGISTRAR / ADDITIONAL / JOINT / DEPUTY ASSISTANT REGISTRAR.

1	Name	Age	Disputants
	Occupation	Address
2	Name	Age
	Occupation	Address
3	Name	Age
	Occupation	Address
Versus
1	Name	Age	Opponents
	Occupation	Address
2	Name	Age
	Occupation	Address
3	Name	Age
	Occupation	Address

(Here give full particulars of the claim or the facts of the case constituting the cause of action when it arose etc.,)

The disputant / disputants prays / pray as under:

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In support of the above claim or relief sought I / We enclose documents and papers as per the list annexed hereto.
Date : Signed _________

Disputant / Disputants.

I / We Disputant / disputants declare that the facts stated above are true to the best of my / our knowledge and belief.
Date : Signed (1) :
(2) : Disputants
(3) :
Filed in the office of ________________ on _______________ 20 ___ .

NOTE :

1. In case there are more disputants or opponents, their names, addresses, age and occupations should also be mentioned.
2. In disputes relating to monetary claims, the disputants should state the precise amount claimed but where this cannot be exactly ascertained the disputants shall state the appropriate amount claimed.
3. When the disputant – foreman is a company / cooperative society or a partnership firm, a copy of the resolution of its Board of Directors or as the case may be, Managing Committee shall accompany the application.