人民調(diào)解協(xié)議書-4

本協(xié)議共_____頁(yè)，第_____頁(yè)人民調(diào)解協(xié)議書___________________人民調(diào)解委員會(huì)（）調(diào)字第號(hào)當(dāng)事人基本情況：當(dāng)事人方姓名性別年齡民族籍貫工作單位、職位或現(xiàn)居住地址居民身份證號(hào)碼其他各方申請(qǐng)人為甲方，被申請(qǐng)人為乙方統(tǒng)稱當(dāng)事人，與案件有利害關(guān)系的人為其他方。上列甲乙雙方當(dāng)事人于______年______月______日發(fā)生糾紛，甲方于______年______月_______日請(qǐng)求我調(diào)委會(huì)予以調(diào)解，經(jīng)征求乙方和其他方意見(jiàn)，同意調(diào)解，我調(diào)委會(huì)于______年______月_______日開始對(duì)糾紛進(jìn)行調(diào)解，調(diào)解前，我調(diào)委會(huì)已向各方當(dāng)事人告知有關(guān)人民調(diào)解的性質(zhì)和參與調(diào)解的權(quán)利和義務(wù)。經(jīng)我調(diào)委會(huì)調(diào)解，各方當(dāng)事人認(rèn)同糾紛的簡(jiǎn)要事實(shí)、爭(zhēng)議事項(xiàng)、各方責(zé)任和糾紛造成的損害，其情況如下：________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________經(jīng)調(diào)解，各方當(dāng)事人自愿達(dá)成以下協(xié)議：________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________本協(xié)議的履行方式為：_______________________________________________________本協(xié)議的履行地點(diǎn)為：_______________________________________________________本協(xié)議的履行期限為：________________________________________________________本協(xié)議具有民事合同性質(zhì)，受法律保護(hù)。各方當(dāng)事人應(yīng)當(dāng)按照協(xié)議自覺(jué)和及時(shí)履行自己的義務(wù)，不得擅自變更或者解除本協(xié)議，否則將承擔(dān)法律責(zé)任。本協(xié)議生效后可能引起的民事訴訟將由本人民調(diào)解委員會(huì)所在地基層人民法院管轄，法律另有規(guī)定的依照規(guī)定。調(diào)解中有關(guān)證據(jù)、材料和調(diào)查談話筆錄共______份，______頁(yè)，原件保存于本次調(diào)解案卷中。本協(xié)議書正本共________份各方當(dāng)事人各執(zhí)一份，本人民調(diào)解委員會(huì)存檔一份，送_____________________________備案_____份，其效力相同。__________方當(dāng)事人簽名：______________________方當(dāng)事人簽名：_______________________方當(dāng)事人簽名：______________________方當(dāng)事人簽名：_____________其他方簽名：______________其他方簽名：______________其他見(jiàn)證人簽名：_______________、簽名：