人民调解申请书
  • 2018-02-10 15:12:39
  • 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(单位/姓名)                         性别        民族       年龄          职业或职务                        

    单位或住址                                                   

    联系方式                                                       

    纠纷简要情况:                                           

                                                                

                                                                

                                                                

                                                                

                                                                 

    当事人申请事项:

                                                           

                                                                

                                                                

                         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):                

                                                   

    审查意见:

        经审查,本案符合受理条件,被申请人XXX同意调解,建议立案,呈主任审批。

     

     

     

                           审查人:

                                                   

                                             

    主任审批意见:

       同意受理,请xxx调解员主持调解。

     

     

     

                            签名:

                                                   

                                             

         市司法局基层工作科审核意见

                  

     

                                         签章