Mediation application form1no. : _ _ _ _ _ _ _ _ _ _ (_ _ _ _ _) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Applicant: _ _ _ _ _ _ _ _ _ _ _
Defendant: _ _ _ _ _ _ _ _ _ _ _
Brief description of the dispute: At about _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
After mediation, the following agreement was reached voluntarily:
1. All medical expenses shall be borne by _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _;
2. _ _ _ _ _ _ _ _ _ and _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Method, place and time limit for performing the agreement: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1. When signing this agreement, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. Before _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
This industrial injury dispute mediation agreement is made in triplicate, one for each party and one for the people's mediation committee.
Party (signature) _ _ _ _ _ _ _ _ _
Mediator (signature) _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Model application for mediation Article 2: Applicant's name: _ _ _ _ _ _ _ _ Gender: _ _ _ _ _ _ Nationality: _ _ _ _ _ _ _ _ Age: _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Occupation or position: _ _ _ _ _ _ _ _ _ _ Contact: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Unit or address: _ _ _ _ _ _ _ _ _ _ _ _
Respondent's name: _ _ _ _ _ _ _ _ Gender: _ _ _ _ _ _ Nationality: _ _ _ _ _ _ _ _ Age: _ _ _ _ _ _ _ _ _
Occupation or position: _ _ _ _ _ _ _ _ _ _ Contact: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Unit or address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Brief description of the dispute: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Matters applicable to all parties
1、________________________________
2、________________________________
3、________________________________
The People's Mediation Committee has informed me of the relevant provisions for applying for people's mediation, and now I voluntarily apply to the People's Mediation Committee for mediation.
Applicant (signature, seal or fingerprint): _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Mediation application model essay 3 XX Traffic Police Brigade of Public Security Bureau:
Party xx, male, born in xx, ID number 5XXXXX, vehicle number XXXXxxxx, contact telephone number xxxx, and lives in XX Group, XX Village, XX County, XX Province. A traffic accident occurred in XX, XX, XX, and he died on the spot. At present, no civil lawsuit has been filed with the people's court. The traffic administrative department of the public security organ is requested to mediate the part of the traffic accident involving XX death compensation.
Request: Request for mediation of all compensation expenses related to Zhang XX's death damages.
Applicant: XX
XX year XX month XX day
Application for mediation model Article 4 Applicants:
Respondents:
Address:
Legal representative:
Mediation request: Pay the applicant's salary during maternity leave in full * * * 65438 yuan +0xx.
Facts and reasons: the applicant has been employed by the respondent since, with a monthly salary of 6000 yuan. I have been working until now. In June this year, the applicant was granted maternity leave for three months because of pregnancy, but the applicant was required to go to work after only two months of maternity leave. So the actual maternity leave is only 2 months. Although the respondent bought some social insurance for the applicant, it didn't buy maternity insurance. Therefore, according to the law, the treatment during maternity leave shall be borne by the respondent. After taking maternity leave, the applicant has been asking the respondent to pay the salary during maternity leave, but the respondent has not answered. It was not until this year1October 9 10 that I received a verbal notice from the personnel manager. According to the notice, all maternity leave in the factory is only paid for two months, and the salary standard is 1 130 yuan per month. This is obviously against our laws.
1 Chinese laws clearly stipulate that maternity leave for female employees is more than 90 days. The defendant stipulated that only two months' salary should be paid.
2. According to Item 2, Paragraph 1, Article 15 of the Regulations on Maternity Insurance for Employees in Guangdong Province: "Female employees enjoy maternity allowance during maternity leave. Maternity allowance is based on the average monthly salary of employees in the last year as a whole, and is calculated and paid in accordance with the provisions of maternity leave. If the maternity allowance is lower than my salary standard, it will be made up by the employer. " It is obviously illegal for the respondent to deliberately avoid the provision that "if the maternity allowance is lower than his salary standard, it shall be made up by the employer", and it shall be based on the average monthly salary of Dongguan employees 10+0 130. According to my monthly salary of 6,000 yuan, the maternity allowance is far lower than my salary standard, so the respondent should pay according to the standard of 6,000 yuan.
In order to protect the legitimate rights and interests of the applicant and maintain harmonious labor relations in China, I hereby apply to your Committee for mediation. Please mediate according to law.
Applicant:
Applicant: Name (or employer's name)
Address: position (job):
Legal Representative: Position:
Entrusted agent:
Defendant: Name (or employer's name)
Address: position (job):
Legal Representative: Position:
Entrusted agent:
Subject matter: application for mediation due to a dispute in ××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××
Mediation request:
Facts and reasons:
To this end, apply to the ××××× Labor Dispute Mediation Committee for mediation, please mediate according to law.
Applicant: (signature or seal)
_ year _ month _ day
Model Mediation Application Form 5 Applicant: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Title of Legal Representative: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Respondent: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Title of Legal Representative: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Subject matter: disputes arising from _ _ _ _ _ _ _ _ _
Mediation request:
Facts and reasons:
To this end, apply to the _ _ _ _ _ court for mediation, please mediate according to law.
(Signature or seal of the applicant)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ Traffic Police Force:
(Name of Party) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Requested items:
Applicant: _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Model Mediation Application Article 6 xxxx Traffic Police Force:
(Name of the party concerned) xxx, gender xx, age XXXXX, ID number XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Now we ask your team to mediate the compensation for traffic accident damage.
Please make a request.
1 ......................................................
2 ......................................................
three .......................................................
Applicant xxxx
Year xxx month xxx day xxx