人民调解协议书

编号：                   当事人（自然人姓名、性别、年龄、民族、职业、单位或住址，法人及社会组织的名称、地址、法定代表人姓名和职务）：                                                                                                                                                                                                                  纠纷简要情况：                                                                                                                                                                                                                                                                           经调解，自愿达成如下协议：                                                                                                                                                                                                                                                              履行协议的方式、地点、期限：                                                                                                                                                                                                                                             本协议一式        份，当事人、人民调解委员会、所属街道司法所各执一份。   当事人（签名或盖章）                                                                                                                    调解员（签名）                                                                        （人民调解委员会盖章）                                                   年       月     日