________________, Applicant

v.

_______________________________,

Respondent

Part I: Information concerning the personal and official status of the applicant

1. Name of respondent
2. Applicant:
   1. name and first names
   2. date and place of birth
   3. marital status
   4. nationality
   5. contact information
      1. address for purposes of the proceedings
      2. email address
      3. phone number
3. Name and address of lawyer or staff member or retired staff member representing the applicant before the Tribunal
4. Official status of applicant:
   1. organization of which the applicant was a staff member at the time of the decision contested
   2. date of employment
   3. title and level at time of decision contested
   4. salary of applicant at the time of decision contested
   5. type of applicant’s appointment
   6. visa status, if applicable
5. If the applicant was not a staff member at the time of the contested decision, state:
   1. the name, first names, nationality and official status of the staff member whose rights are relied on
   2. the relation of the applicant to the said staff member which entitles the former to come before the Tribunal
6. Date of the occurrence of the event or date of decision giving rise to the application
7. Date of receipt of notice
8. Date of receipt of notice that the relief asked for or recommended will be granted, if such relief shall not have been granted within thirty days after receipt of such notice
9. Description of remedies exhausted within the respondent institution
10. Applicants who are filing applications after they have been separated from the Bank’s employment should indicate all employment, including self-employment, since the date of separation, stating the nature and periods of such employment, the names of all employers and gross payments received in respect of such employment

Part II: Pleas

1. Any preliminary or provisional measures, such as the production of additional documents or the hearing of witnesses, which the applicant is requesting the Tribunal to order before proceeding to consider the merits
2. The decisions which the applicant is contesting and whose rescission is requested under Article XII, paragraph 1, of the Statute
3. The obligations which the applicant is invoking and the specific performance of which is requested under Article XII, paragraph 1, of the Statute
4. The amount of compensation claimed by the applicant
5. Any other relief requested by the applicant 
6. The amount of costs requested by the applicant

Part III: Explanatory statement

Part IV: Annexes