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：⑴当事人申请；⑵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。
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，自愿达成如下协议：_____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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)________________________
