MODELO DE SOLICITUD DE CONCILIACIÓN EXTRAJUDICIAL

SOLICITO: SE CONVOQUE A CONCILIACIÓN

SEÑOR DIRECTOR DEL CENTRO DE CONCILIACION EXTRAJUDICIAL PROD

DATOS DEL (LOS) SOLICITANTE (S):

1.-NOMBRE Y APELLIDOS: ___________________________________________________

DNI: ___________________________________________________________________

DOMICILIO: _____________________________________________________________

2.-RAZÓN SOCIAL: _________________________________________________________

R.U.C.:__________________________________________________________________

DIRECCIÓN: _____________________________________________________________

REPRESENTANTE LEGAL: ___________________________________________________

DNI:____________________________________________________________________

DATOS DE LA(S) PERSONAS QUE SE INVITA A CONCILIAR:

1.-NOMBRE Y APELLIDOS: ___________________________________________________

DOMICILIO: _______________________________________________________________________

REFERENCIA: ________________________________________________________________________

2.-RAZÓN SOCIAL: ________________________________________________________

R.U.C.:__________________________________________________________________

DIRECCIÓN: _______________________________________________________________________

REFERENCIA: ______________________________________________________________________

HECHOS QUE DAN LUGAR AL CONFLICTO:

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PRETENSIONES:

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DOCUMENTO QUE SE ADJUNTAN:

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

LIMA, ______________DE__________________________________DEL 2016.

FIRMA:______________________________