EA SUBMISSION FORM Form No: 104

(For appointing Emergency Arbitrator under Schedule-1 or Schedule-2 of the IIAM Arbitration Rules)

Emergent Arbitrator required for: Interim measures of protection

AMA Procedure

DETAILS OF PARTIES:

Name of Applicant(s):

Address:

Tel / Mobile / Email:

Name of Opposite Party/ies:

Address:

Tel / Mobile / Email:

1. A separate application for appointment of Emergency Arbitrator for the above purpose, detailing the circumstances
giving rise to the application and reliefs sought, with the details of the underlying disputes referred to arbitration,
along with a copy of the arbitration agreement is attached.
2. Sufficient number of application, to provide one copy for the arbitrator, plus certified true copies sufficient for
serving to all other parties and one for IIAM is filed
3. Appropriate registration / filing fee as provided in the IIAM Arbitration Fee Schedule has been paid.

Date: Name & Signature:

• Use additional sheets wherever required