Claim For Property Damage printable pdf download

Claim For Property Damage

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.

)

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)

Claim For Property Damage