001
(Revised January 2006)
Republic of the Philippines
Department of Trade and Industry
Construction Industry Authority of the Philippines
CONSTRUCTION INDUSTRY ARBITRATION COMMISSION
RESPONDENT
NAME OF COMPANY : _______________________________________________________________________________________
AUTHORIZED
REPRESENTATIVE : _______________________________________________________________________________________
BUSINESS ADDRESS : _______________________________________________________________________________________
TELEPHONE NUMBER : _______________________________________________________________________________________
III. Choice of Arbitrators: Maximum of Six [6] Nominees (By Order of Preference)
1. ______________________________________ 4. ___________________________________
2. ______________________________________ 5. ___________________________________
3. ______________________________________ 6. ___________________________________
VI. Documents Required : Please submit the following in: 5 copies if Tribunal / 3 copies if Sole Arbitrator
[ ] Complaint/Narration of Facts
[ ] Construction contract
[ ] Agreement to arbitrate
[ ] Documents establishing the circumstances of the case
[ ] In case of government contract, communications made with the highest authority for exhaustion
of administrative remedies.
_______________________________________
Date Filed : ____________________________ Signature of Authorized Representative
Case Number : ____________________________
Deposit Paid : ____________________________
O.R. No. : ____________________________ CTC No. : ____________________________
Date Issued : ____________________________ Issued at : _____________________________
Remarks : ____________________________ Issued at : _____________________________
________________________________________________ TIN : _____________________________