(a) The notice of appeal shall be in substantially the following form:

1. (1) the compensation of the arbitrators has been paid,

   or

2. (2) application has been made for permission to proceed in forma pauperis. (Strike out the inapplicable clause.)

   Appellant or Attorney for Appellant

   Official Note

   The demand for jury trial on appeal from compulsory arbitration is governed by Rule 1007.1(b).

(Caption)
NOTICE OF APPEAL
FROM AWARD OF BOARD OF ARBITRATORS

TO THE PROTHONOTARY:

Notice is given that

appeals from the award of the board of arbitrators entered in this case on .

A jury trial is demanded . [Check box if a jury trial is demanded. Otherwise jury trial is waived.)

I hereby certify that