人民调解协议书-4

本协议共_____页，第_____页人民调解协议书___________________人民调解委员会（）调字第号当事人基本情况：当事人方姓名性别年龄民族籍贯工作单位、职位或现居住地址居民身份证号码其他各方申请人为甲方，被申请人为乙方统称当事人，与案件有利害关系的人为其他方。上列甲乙双方当事人于______年______月______日发生纠纷，甲方于______年______月_______日请求我调委会予以调解，经征求乙方和其他方意见，同意调解，我调委会于______年______月_______日开始对纠纷进行调解，调解前，我调委会已向各方当事人告知有关人民调解的性质和参与调解的权利和义务。经我调委会调解，各方当事人认同纠纷的简要事实、争议事项、各方责任和纠纷造成的损害，其情况如下：________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________经调解，各方当事人自愿达成以下协议：________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________本协议的履行方式为：_______________________________________________________本协议的履行地点为：_______________________________________________________本协议的履行期限为：________________________________________________________本协议具有民事合同性质，受法律保护。各方当事人应当按照协议自觉和及时履行自己的义务，不得擅自变更或者解除本协议，否则将承担法律责任。本协议生效后可能引起的民事诉讼将由本人民调解委员会所在地基层人民法院管辖，法律另有规定的依照规定。调解中有关证据、材料和调查谈话笔录共______份，______页，原件保存于本次调解案卷中。本协议书正本共________份各方当事人各执一份，本人民调解委员会存档一份，送_____________________________备案_____份，其效力相同。__________方当事人签名：______________________方当事人签名：_______________________方当事人签名：______________________方当事人签名：_____________其他方签名：______________其他方签名：______________其他见证人签名：_______________、签名：