Official Federal Forms > American Arbitration Association > Government And Consumer
MN Petition For No-Fault Arbitration Form - Official Federal Forms
| MN Petition For No-Fault Arbitration Form Form. This is a national form and can be used in Government And Consumer American Arbitration Association . |
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PETITION FOR NO-FAULT ARBITRATION The named Claimant(s), pursuant to M.S.A. 65B.525, hereby tender(s) the following dispute arising out of a no-fault insurance policy for resolution under the Minnesota No-Fault Comprehensive or Collision Damage Automobile Insurance Arbitration Rules administered by the American Arbitration Association. Insurance Company: ___________________________________________Claim #___________________________ Street: ______________________________________________________Policy #__________________ City: __________________State: ________Zip: _________________ Phone _____________________ Policyholder: ________________________________________ Accident Date _____________________ Name(s) of Claimant(s): ___________________________________________ Minor Y N _________ Total Amount Claimed _______________________ Hearing Locale Requested_______________________________________________________________________ I affirm that the information contained herein is true to the best of my knowledge. Date:___________________________Signed:____________________________________________ (Must be signed by Claimant or Claimant's representative) Name of Filing Party: ___________________________ Phone _________________________________ Address: __________________________ City: ________________ State: _________ Zip ___________ If an attorney will be representing you, please complete items below: Attorney: _______________________________________ Phone ______________ Fax _____________ E-mail ___________________________ Street Address: _____________________________City: _________________State: ________ Zip ______________ The following must be included: Non-refundable $45.00 filing fee (check made payable to the American Arbitration Association). Send to: American Arbitration Association 700 Pillsbury Center 200 South Sixth Street Minneapolis, MN 55402 American LegalNet, Inc. www.FormsWorkFlow.com
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