Name Address Tel. No. Attorney for IN THE CIRCUIT COURT OF THE CIRCUIT STATE OF HAWAI221I ) CIVIL NO. ) ) REQUEST TO EXEMPT CASE ) FROM THE COURT ANNEXED ) ARBITRATION PROGRAM; Plaintiff(s),) SUMMARY OF FACTS ) vs. ) ) ) ) ) ) Defendant(s). ) ) REQUEST TO EXEMPT CASE FROM THE COURT ANNEXED ARBITRATION PROGRAM Comes now , by and through (his/her/its/their) attorney(s), and hereby requests that the above entitled matter be exempt from the Court Annexed Arbitration Program, as the probable jury award value, not reduced by the issue of liability, and exclusive of attorney325s fees, interest and cost, is in excess of $150,000.00. This request is made pursuant to Rule 8 (A) of the Hawai221i Arbitration Rules, as amended, and the Summary of Facts attached hereto. DATED: , Hawai324i, . CAAP 3.DOC Attorney for 1C-P-524 (08/05) American LegalNet, Inc. www.FormsWorkFlow.com