編號：                   當(dāng)事人（自然人姓名、性別、年齡、民族、職業(yè)、單位或住址，法人及社會組織的名稱、地址、法定代表人姓名和職務(wù)）：                                                                                                                                                                                                                  糾紛簡要情況：                                                                                                                                                                                                                                                                           經(jīng)調(diào)解，自愿達(dá)成如下協(xié)議：                                                                                                                                                                                                                                                              履行協(xié)議的方式、地點、期限：                                                                                                                                                                                                                                             本協(xié)議一式        份，當(dāng)事人、人民調(diào)解委員會、所屬街道司法所各執(zhí)一份。   當(dāng)事人（簽名或蓋章）                                                                                                                    調(diào)解員（簽名）                                                                        （人民調(diào)解委員會蓋章）                                                   年       月     日