By email to casework@lcia.org

London Court of International Arbitration

70 Fleet Street

London

EC4Y 1EU

United Kingdom

Date

Dear Registrar of the LCIA Court,

Request for Arbitration: Party names

Law firm case reference number

This letter is a Request for Arbitration under Article 1 of the LCIA Rules of Arbitration on behalf of name of claimant party for whom we act.

In accordance with Article 1 of the LCIA Rules of Arbitration, please be informed:

• the names, addresses, telephone, facsimile, and e-mail numbers/addresses of the parties to the arbitration

• the names, addresses, telephone, facsimile and e-mail numbers/addresses of the parties' legal representatives

• a brief statement describing the nature and circumstances of the dispute, the estimated monetary amount or value, the transaction at issue, and setting out the claimant's claims against the respondent

• a statement of any matters agreed in writing between the parties or on which the claimant wishes to make proposals (i.e., seat, language, number of arbitrators or their qualifications or nominations for arbitrators, or proposals the claimant wishes to make under the arbitration agreement)