卷  内  目  录

人民调解申请书

申请人姓名               性别       民族           年龄            

职业或职务                        联系方式                             

单位或住址                                                             

被申请人姓名            性别        民族        年龄               

职业或职务                        联系方式                              

单位或住址                                                              

纠纷简要情况                                                             

                                                                       

                                                                       

                                                                      

                                                                        

当事人申请事项1、                                  

2、                                   

3、                                    

人民调解委员会已将申请人民调解的相关规定告知我，现自愿申请人民调解委员会进行调解。

                          申请人（签名盖章或按指印）             

                                           年      月      日

人民调解受理登记表

          年     月      日，人民调解委员会依当事人申请（人民调解委员会主动调解），经当事人同意，调解          、           之间的纠纷。

纠纷类型：                                                        

案件来源：①当事人申请②人民调解委员会主动调解

纠纷简要情况：                                                     

                                                                         

                                                                                 

                                                                       

                                                                      

                                                                       

                                                                       

                                                                      

当事人（签名）                               

登记人（签名）                  

                                                人民调解委员会

                                            年      月       日

人民调解调查记录

时  间                              

地  点                               

参加人                              

被调查人                            

记录：                                                                     

                                                                          

                                                                       

                                                                      

                                                                      

                                                                              

                                                                        

                                                                     

调 查 人（签名）            

被调查人（签名）            

记 录 人（签名）            

人民调解记录

时  间                              

地  点                              

当事人                              

参加人                            

人民调解委员会已将人民调解的相关规定告知各方当事人。

调解记录：                                                                  

                                                                      

                                                                       

                                                                        

                                                                      

                                                                        

                                                                       

                                                                       

                                                                        

调解结果：

1、调解成功；2、调解不成；3、有待继续调解

当事人（签名盖章或按指印）               

当事人（签名盖章或按指印）               

人  民  调  解  员（签名）               

记      录      人（签名）               

                                               年      月       日

人民调解协议书

                                              编号                 

当事人姓名                  性别      民族          年龄        

职业或职务                           联系方式                         

单位或住址                                                             

当事人姓名                  性别      民族          年龄        

职业或职务                           联系方式                         

单位或住址                                                              

纠纷主要事实、争议事项：                                          

                                                                      

                                                                      

                                                                         

经调解，自愿达成以下协议：                                       

                                                                        

                                                                           

履行方式、时限                              

本协议一式          份，当事人、人民调解委员会各持一份。

当事人（签名盖章或按指印）               人民调解员（签名）        

当事人（签名盖章或按指印）               记录人（签名）              

                                        （人民调解委员会印章）

                                                 年     月      日

人民调解回访记录

当 事 人                             

调解协议编号                         

回访事由                             

回访时间                             

回访情况：                                                                    

                                                                        

                                                                      

                                                                      

                                                                           

                                                                       

                                                                      

                                                                         

                                                                       

                                                                      

回访人（签名）               

                                                       人民调解委员会

                                               年      月       日

卷宗情况说明

                                               

                                               

                                                

                                                   

                                                

                                                

                                                

                                                

                                                 

                                                  

                                                  

                                               

                                                  

                                                 

                                                

                        立卷人                 

 

 

第二篇：3人民调解申请书(第1-2页)

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