MODELO DE SOLICITUD DE CONCILIACIÓN CONJUNTA

SOLICITO: SE CONVOQUE A CONCILIACIÓN CONJUNTA.

SEÑOR DIRECTOR DEL CENTRO DE CONCILIACION EXTRAJUDICIAL PROD

I. DATOS DEL (LOS) SOLICITANTE (S):

POR UNA PARTE:

1.-NOMBRE Y APELLIDOS: ____________________________________________________

DNI: ____________________________________________________________________

DOMICILIO: ______________________________________________________________

2.-RAZÓN SOCIAL: __________________________________________________________

R.U.C.:___________________________________________________________________

DIRECCIÓN: ______________________________________________________________

REPRESENTANTE LEGAL: ____________________________________________________

DNI:_____________________________________________________________________

POR OTRA PARTE:

1.-NOMBRE Y APELLIDOS: ____________________________________________________

DNI: ____________________________________________________________________

DOMICILIO: _______________________________________________________________

2.-RAZÓN SOCIAL: __________________________________________________________

R.U.C.:___________________________________________________________________

DIRECCIÓN: ______________________________________________________________

REPRESENTANTE LEGAL: ____________________________________________________

DNI:_____________________________________________________________________

II HECHOS QUE DAN LUGAR AL CONFLICTO:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

III PRETENSIONES:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

IV DOCUMENTO QUE SE ADJUNTAN:

1. COPIA(S) DE DNI.
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
5. _____________________________________________________________________
6. _____________________________________________________________________

LIMA, ______________DE__________________________________DEL 2020.

FIRMA:______________________________