Joint appointment of single arbitrator

In the Matter of an intended Arbitration between [parties]

WHEREAS disputes and differences have arisen between us the undersigned [insert the name, address etc. of party] and [insert the name, address etc. of other party] within the meaning of the arbitration clause contained in a deed [or an agreement] dated the _____ day of ______ and made between [parties] and we are desirous of having the said disputes and differences settled by arbitration.

NOW THEREFORE in pursuance of the provisions of the said deed [or agreement] we hereby nominate and appoint you [arbitrator] of [address, etc.]

[Signature of appointor]