Autorizado su funcionamiento por Resolución.

Directorial Nº 177-2007-JUS/DNJ-DCMA
Av. Roosevelt (Ex República de Panamá) Nº 5893, Mezanine, Urb. Aurora Mirafkores, Lima
Teléfonos 446-4863 / 241-1572 e mail: aspecoar@yahoo.com

Exp. N°_________2015.

SOLICITUD PARA CONCILIAR

I. DATOS GENERALES:

1. Fecha __________ de _____________________ del 2015.

2. Nombre o Razón Social de (los ) Solicitante (s)

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3. Documento de Identidad o RUC del (los) Solicitante (s)

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4. Domicilio del (los) solicitante (s)

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5. Nombre del Apoderado o representante

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6. Domicilio del Apoderado o representante

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7. Nombre o razón social del (los) invitado (s)

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8. Domicilio (s) del (los) invitado (s)
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II. HECHOS QUE DIERON LUGAR AL CONFLICTO:
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III. OTRAS PERSONAS CON DERECHO ALIMENTARIO (solo para Alimentos )

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IV. PRETENSIÓN:
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V. FIRMA DEL SOLICITANTE O HUELLA SEGÚN EL CASO

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D.N.I. Nº

VI. DOCUMENTOS QUE ADJUNTO :

1. Copia de D.N.I.
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