​To
John Deaton Adjudicator
44 South Richmond Street
Dublin 2                                                                       Date
 
By letter and e mail- jdeaton@dlarch.ie
 
REQUEST FOR  ADJUDICATION
 
Dear Mr Deaton
 
I/We  hereby request you to act as adjudicator in the dispute described below:
 
My details(referring party)
Name of person or company
Trading name if different
Address
Phone no.
Email
 
Responding party (on whom notice of adjudication has been served)
Name of person or company
Trading name if different
Address
Phone no.
Email
 
Claim details
Site address
Project
Amount disputed
 
Date when notice of adjudication was served on the responding party.
Date
 
I enclose/attach a copy of the notice of adjudication.
 
This request is made subject to agreement on your terms of appointment including fees and expenses and subject to agreement of the responding party.
 
Signed
Signature
Name (printed)
Capacity (director, sole trader etc.)