For the purposes of paragraph 73 (2) (b) of the Act, the following particulars are prescribed:
(a) the name and address of the applicant;
(b) whether the applicant is the lessor or tenant;
(c) the address of the premises that are the subject of the residential tenancy agreement;
(d) the action sought by the applicant to be taken to facilitate the resolution of the dispute;
(e) the grounds on which the application is made.