人民调解委员会卷宗.docx
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人民调解委员会卷宗
______________________人民调解委员会
调解卷宗
卷名:
_____________________________________
卷号:
____________________________________
人民调解员:
____________________________________
调解日期:
____________________________________
立卷人:
____________立卷日期:
________________
保管期限:
______________________________________
备注:
______________________________________
人民调解卷宗目录
序号
文书名称
页号
备注
1
人民调解申请书
2
人民调解受理登记表
3
人民调解调查记录
4
人民调解证据材料
5
人民调解记录
6
人民调解协议书或人民调解口头协议登记表
7
人民调解回访记录
8
司法确认有关材料
9
卷宗情况说明
10
封底
10
11
12
本卷第页
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有关规定告知我,现自愿申请人民调解委员会进行调解。
申请人(签名或按指印):
___________________
___________年_____月____日
本卷第页
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
备注:
此表由人民调解委员会填写
本卷第页
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):
________________________________________
本卷第页
人民调解记录
时间:
_____________________________________
地点:
____________________________________
当事人:
____________________________________
参加人:
____________________________________
记录人:
____________________________________
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:
______________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________本卷第页____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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
本卷第页
人民调解协议书
吴()民调字第【】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,自愿达成如下协议:
______________________________
___________________________________________________________
___________________________________________________________
本卷第页_________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
协议履行的方式、地点、期限:
___________________________
______________________________________________________________________________________________________________________
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):
______________________________
当事人(签名盖章或按指印):
______________________________
调解员(签名):
__________________________________________
记录员(签名):
__________________________________________
________________人民调解委员会(印章)
___________年______月_____日
本卷第页
人民调解口头协议登记表
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,自愿达成如下协议:
_______________________________
______________________________________________________________________________________________________________________
协议履行的方式、地点、期限:
___________________________
人民调解员(签名):
__________________
____________人民调解委员会(印章)
_______年______月_____日
备注:
此表由人民调委会填写
本卷第页
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
本卷第页
卷宗情况说明
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
立卷人:
______________________
本卷第页
封底
立卷人:
__________________________
审核人:
__________________________
立卷日期:
_______年_______月______日