Appendix I


REQUEST FOR ARBITRATION/APPEAL

We, the undersigned, hereby request for arbitration/appeal under the PORAM Rules of Arbitration and Appeal, on dispute(s) that has/have arisen with                     (name of Respondent)                      under the following contract(s) :
 
i)
 Contract Number(s)and Date(s)
:
 
ii)
 Governing Contract Terms
:
 
iii)
 Governing Arbitration Rules
:

Copy of the contract(s) is/are attached.

Details of parties to the dispute(s) :
   
Claimant/Appellant

  
Respondent
Name of company
 
 :
 
 _____________________________
 		   _____________________________
 
Contact address
(including telephone and
fascimile numbers)
 
 
 
 :
 
 
 
 
 
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
 
  
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
 
Contact person : _____________________________
   _____________________________

The deposit for arbitration costs/fees of RM _______________ payable to "The Palm Oil Refiners Association of Malaysia" is enclosed.

Brief description of the dispute
 
 
 
 
 
 
 		 :
 
 
 
 
 
 
 		 ______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________


Signature and name of
person submitting this
request

:
 
 

_____________________________________

_____________________________________

Name of company
:
_____________________________________

Date
 
 
:
 
 
_____________________________________