Free Acrobat - South Carolina

STATE OF SOUTH CAROLINA

) BEFORE THE ARBITRATION PANEL OF ) ____________________ COUNTY In the matter of Arbitration between )
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) Case number ____-CP-____-______
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Claimant(s) ) CLAIM FOR PROPERTY DAMAGE ) vs. )
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Defendant(s) ) The Claimant(s), complaining of the Defendant(s) hereby files a claim for property damages arising out of a motor vehicle collision and requests that the matter be submitted to arbitration, and allege: 1. The Claimant(s) resides in _________________ County. 2. The Defendant(s) resides in _________________ County. 3. The collision occurred in _________________ County. 4. The collision occurred on ______________ at _______________________________________ ________________________________________________________________________________. 5. As a result of said collision, due to the negligent and reckless acts of the Defendant(s), the Claimant(s) have suffered property damage in the amount of _______________________________________________________________, actual and punitive. WHEREFORE, Claimant(s) requests that this claim be arbitrated and that property damages be awarded in the amount of ____________________________________________________________ _________________________________________, actual and punitive. Attorney for Claimant(s): Claimant(s):

DATE: ___________________
THIS FORM SHALL BE ARBITRATED BY A PANEL OF THREE (3) ARBITRATORS TO BE APPOINTED BY THE CLERK OF COURT UNLESS WITHIN TEN(10) DAYS FROM THE FILING OF A RESPONSE BY THE DEFENDANT(S), THE CLAIMANT(S) AND DEFENDANT(S) SHALL AGREE, IN WRITING, TO HAVE SUCH CLAIM HEARD BY A SINGLE ARBITRATOR. A FORM OF AGREEMENT IS AVAILABLE IN THE CLERK'S OFFICE.

SCCA/201(3/2005)