Urgent Interim Measures Application

Date *

Claimant filing the Urgent Interim Measures Application *

Organization

Address *

Address

City

State/Province

Zip/Postal

Country

Phone *

Fax

Email *

Claimant's Counsel *

Organization

Address *

Address

City

State/Province

Zip/Postal

Country

Phone *

Fax

Email *

Respondent - 1 *

Organization

Address *

Address

City

State/Province

Zip/Postal

Country

Phone *

Fax

Email *

Respondent's Counsel *

Organization

Address *

Address

City

State/Province

Zip/Postal

Country

Phone *

Fax

Email *

Respondent - 2 (if applicable)

Organization

Address

City

State/Province

Zip/Postal

Country

Phone

Fax

Respondent's Counsel

Organization

Address

City

State/Province

Zip/Postal

Country

Phone

Fax

Respondent - 3 (if applicable)

Organization

Address

City

State/Province

Zip/Postal

Country

Phone

Fax

Respondent's Counsel

Organization

Address

City

State/Province

Zip/Postal

Country

Phone

Fax

1. Provide a Brief Description of the circumstances that led to the Urgent Interim Measures application: *

2. Provide a Description of the underlying dispute: *

3. Provide a statement of the Urgent Interim Measures the party seeks: *

4. Provide a statement of the reasons the applicant needs Urgent Interim Measures that cannot wait for the constitution of the Tribunal: *

Please append the following: a) A copy of the Arbitration Agreement and any relevant agreement(s)

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b) Any agreement about the location(s) of the arbitration hearings and meetings, or the rules of law that apply

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and c) Copies of any Notice of Request to Arbitrate, Notice of Submission to Arbitration, and any other submissions related to the dispute that have been delivered to the DRB by any of the parties before the Urgent Interim Measures application

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Signature *

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