Arbitration Registration Form

a. Information of the claimant

Name :

Address :

Telephone number:

Email:

Place of residence:

VAT number :

Where relevant, information authorised representative claimant

Name representative:

Address :

Telephone number:

E-mail

Place of residence:

b. Information defendant

Name :

Address :

Telephone number:

E-mail

Place of residence:

VAT number :

Where relevant, information authorised representative defendant

Name representative:

Address :

Telephone number:

Place of residence:

E-mail

c. A short description of the dispute

The objective of this description is to inform the TAMI administrator on the nature and scope of the
case. This description does not alter the parties’ right to deliver a statement of claim or a statement
of defence. De description of the dispute can also be provided for as an annex to the request.

d. Arbitration agreement and any other agreements

The understanding between the parties that their disputes shall be settled by arbitration according to
TAMI’s rules of procedure must be apparent from an arbitration agreement (arbitration clause,
arbitral compromise). Please enclose a copy of the relevant agreement(s) or any other documents
with the request.

e. General description of the claim and, if possible, a specification of the financial interests of
each claim.

The objective of this general description is to inform the TAMI administrator on the
nature and scope of the case. This description shall be without prejudice to the right of the parties to
change, increase, or reduce a claim within the terms of TAMI’s rules of procedure.

f. The appointment of arbitrators

TAMI’s rules of the procedure take the position that the parties themselves appoint the arbitrator.
Where the parties have agreed on the appointment of three arbitrators, each party will appoint one
arbitrator, and these two appointed arbitrators will appoint the third arbitrator, who will also be the
president (of the arbitral tribunal).
In appointing an arbitrator, the parties have the option of using suggestions of TAMI for arbitrator
candidates. When the parties appoint the arbitrator(s) themselves, please fill in the information below:
Claimant appoints /parties jointly appoint:

Arbitrator 1

Name arbitrator 1 :

Address :

Place of residence:

Email :

Telephone number:

Arbitrator 2

Name arbitrator 2 :

Address :

Place of residence:

Email :

Telephone number:

President:

Name arbitrator 3 :

Address :

Place of residence:

Email :

Telephone number:


An arbitrator should be impartial and independent. He or she may not have close personal or
business relationships with one of the parties nor with the other arbitrators. He or she may not have
any direct personal or commercial interest in the outcome of the case. At the same time, the
arbitrator may not have expressed his or her opinion on the case to either party before his or her
appointment.

Where arbitrator(s) have not yet been appointed by the parties and they wish to use TAMI’s
suggestions for arbitrator candidates in conformity with article 12 of the rules of procedure, you will
state so below (or in an appendix to the request).

g. Number of arbitrators (Article 7(2)(i))

There must be an odd number of arbitrators. If there is disagreement among the parties on the
number of arbitrators, the TAMI administrator will determine the number to one or three, depending
on the nature and the scope of the case. With regard to the number of arbitrators:

(a) The parties have agreed that the arbitration tribunal comprises arbitrator(s).

(B) The parties have not agreed anything, but the claimant prefers arbitrator(s).

h. Qualification of the arbitrator(s)

With regard to the arbitrator's qualifications:

(a)The parties have agreed that the arbitrator will need to have the following qualifications:

(b) The parties have not agreed anything, but the claimant prefers:

i. Place of arbitration

The parties determine the place of mediation, failing which the arbitral tribunal will do so.
With regard to the place of arbitration:

(a) The parties have agreed that this will have to be:

(b) The parties have not agreed on anything but the claimant prefers:

j. Language of the arbitration

With regard to the language of the arbitration:

(a) The parties have agreed that this will have to be the (either English or
Dutch) language.

Dutch (Nederlands)English (Engels)

(b) The parties have not agreed on anything but the claimant prefers:
(either English or Dutch) language.
Dutch (Nederlands)English (Engels)

k. Other particulars as regards the arbitration procedure
If the parties wish to communicate particular aspects TAMI needs to be aware of in the context of
the arbitration procedure, the parties may do so here.

I accept the terms and conditions