CIAC Form No.

001
(Revised January 2006)
Republic of the Philippines
Department of Trade and Industry
Construction Industry Authority of the Philippines
CONSTRUCTION INDUSTRY ARBITRATION COMMISSION

REQUEST FOR ARBITRATION

I. The Parties
CLAIMANT

NAME OF COMPANY : BRIEL TURIJA CONSTRUCTION, INC.

AUTHORIZED
REPRESENTATIVE : BRIEL TURIJA
BUSINESS ADDRESS : 647 Real St, Downtown, Tacloban City, 6500 Leyte
TELEPHONE NUMBER : (053) 323-2857

RESPONDENT
NAME OF COMPANY : GRAVOSO & SONS, INC.
AUTHORIZED
REPRESENTATIVE : CHRISTIANNE DOMINIQUE GRAVOSO
BUSINESS ADDRESS : Jones St. Ext., Brgy. 2, Tacloban City
TELEPHONE NUMBER : (053) 832-1088

II. Mode of Arbitration: [/] Sole Arbitrator [ ] Arbitral Tribunal

III. Choice of Arbitrators: Maximum of Six [6] Nominees (By Order of Preference)

1. Alikpala, Federico Y. 4. Jovellanos, Jose U.

2. Andrada, Danilo T. 5. Lazatin, Victor P.
3. Evangelista, Eliseo I. 6. Mansueto, Antonio A.

IV. Agreement to Arbitrate

Is there an arbitration clause in the contract? [/] Y [ __ ] N. If none, please accomplish the AGREEMENT
TO ARBITRATE at the back hereof. In case of government contract, have all administrative remedies
been exhausted? [ __ ] Y [ __ ] N .

V. Sum in Dispute : THREE MILLION PESOS (PHP3,000,000)

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.

BRIEL U. TURIJA__________
Date Filed : April 2, 2020 Signature of Authorized Representative
Case Number : 16253
Deposit Paid : ____________________________
O.R. No. : ____________________________ CTC No. : ____________________________
Date Issued : ____________________________ Issued at : _____________________________
Remarks : ____________________________ Issued at : _____________________________
________________________________________________ TIN : _____________________________