时间：____年____月____日____时____分至_____时____分
　　地点：_____________________________________________
　　会见人（律师）：___________________________________
　　被会见人：_________________________________________

　　案由：   

    ______________________________________________________________________________________________
    ______________________________________________________________________________________________
    ______________________________________________________________________________________________
    ______________________________________________________________________________________________

    记录人：___________________________________________

　　笔录内容：   

    ______________________________________________________________________________________________
    ______________________________________________________________________________________________
    ______________________________________________________________________________________________
    ______________________________________________________________________________________________

被会见人：____（签名或盖章）
________年______月________日

　　附:本会见系第____次。