原告或公诉机关：___________________________
    被告：_____________________________________
    委托人：___________________________________
    地址：_____________________________________
    电话：_____________________________________
    联系人：___________________________________
    承办律师：_________________________________
    案号：_____________________________________
    收费额：___________________________________
    承办律师意见 ：__________________________________________________________________________________________
    _________________________________________________________________________________________________________
    _________________________________________________________________________________________________________
    _________________________________________________________________________________________________________

承办律师意见 （签名）：_______
________年________月________日
批准人意见 （签名）：_________
________年________月________日