CENTRO DE CONCILIACIN, NEGOCIACIN, MEDIACIN Y ARBITRAJE ASS
Resolucin Viceministerial N 176 2001- JUS
SOLICITUD PARA CONCILIAR
EXP N________-20___A DATOS GENERALES: Fecha:_____________ A) Nombre o razn social del (los) solicitantes________________________________________________________ ________________________________________________________________________________________________ Documento de identidad o RUC del (los) solicitante(s)____________________________________________________ Domicilio del (los) solicitante(s)______________________________________________________________________ ________________________________________________________________________________________________ Nombre del apoderado o representante________________________________________________________________ Domicilio del apoderado o representante _______________________________________________________________ ________________________________________________________________________________________________ B) Nombre o razn social del (los) invitado(s)_________________________________________________________ ________________________________________________________________________________________________ Domicilio (s) del (los) invitado(s) ____________________________________________________________________ ________________________________________________________________________________________________ HECHOS QUE DIERON LUGAR AL CONFLICTO: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ OTRAS PERSONAS CON DERECHO ALIMENTARIO (solo en caso de familia) ________________________________________________________________________________________________ ________________________________________________________________________________________________ PRETENSION ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Pido a ustedes acceder a mi solicitud, a fin que proceda conforme a la Ley de Conciliacin y su Reglamento. __________________________________ Firma del solicitante Documentos que adjunto: