ĊENTRU MALTI TAL-ARBITRAĠĠ MALTA ARBITRATION CENTRE

REF No.
______
FORM No. 4

STATEMENT OF CLAIM

PART A[1]: Compulsory Information to be included in the Statement of Claim

DETAILS OF CLAIMANT[2]

NAME
ADDRESS

DETAILS OF RESPONDENT[3]

NAME
ADDRESS

For the purposes of Article 29 of the Arbitration Act, the claimant hereby provides:

  1. A statement of facts supporting the claim:
  1. The point/s at issue:
  1. The relief or remedy sought:

PART B[4]: Documents to be annexed or referred to in the Statement of Claim

The statement of claim is accompanied by the following documents:

  1. A copy of the contract, and of the arbitration agreement if not included in the contract, unless already filed with the Notice of Arbitration.
  1. Other documents, namely:

PART C[5]: Other evidence

Other evidence that will be submitted by claimant:

PART D[6]: Service of the Statement of Claim

The Statement of Claim shall be served on the respondent and the arbitral tribunal: (a) by the claimant or (b) by the Malta Arbitration Centre[7].

PART E: Additional information for the Respondent’s benefit

This form is used when the Statement of Claim has not been submitted with the Notice of Arbitration. If, within the period of time fixed by the arbitral tribunal, the respondent fails to communicate his Statement of Defence without showing sufficient cause for such failure, the arbitral tribunal shall order that the proceedings continue.

Additional Attachments/Documents (please list attachments/documents, if applicable)

______

______

Signature of Claimant/RepresentativeDate

PART F: For office use only

Date of filing of the Statement of Claim: By whom this form has been filed:

[1]Where the space provided is not sufficient, further information may be submitted in separate sheets annexed to this form.

[2] The term ‘claimant’ includes one or more claimants.

[3] The term ‘respondent’ includes one or more respondents.

[4]Where the space provided is not sufficient, further information may be submitted in separate sheets annexed to this form.

[5]Ibid.

[6] Ibid.

[7] Delete as necessary.