立协议人：______________________、_______________________(名称)(下称甲、乙方)
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甲方：________(名称)(公章) 乙方：________(名称)(公章)
法定代表人：姓名、职务(私章) 法定代表人：姓名、职务(私章)
________年________月________日
此致
________人民法院
