Column (to be completed by the case handling department)

Legal status:□Investigation of crimes    □The prosecution   □A trial    □The second instance

The alleged offense:                     Places of detention                     

Column two (by the case handling units to fill in, if not belong to this type, please "type a" front box filled with "*" )

□Type: a legal must inform the legal aid cases

Party:          □ □ male female   Identity card number:                  

Legal situation:  □Has not lost the mental patients to recognize or control his own conduct ability

□Blind, deaf, dumb     □May be sentenced to life imprisonment, the death penalty     □Minors

Column three (by the parties to complete, if not belong to this type, please relevant departments in the "type two" front box filled with "*" )

□Type two: the parties due to financial difficulties or other reasons to apply for legal aid cases

Party:          □ □ male female Identity card number:                  

Compliance with legal aid economic difficulties standards:□Is □Whether or not   Family members            　

Contact telephone number:             Home address:                               

The parties (signature):           Date:    Years  Month  Day

Column four (to be completed by the case handling department)

The case handling department:    Branch Office(Detachment)                Fax telephone:         

The handling a case police:                    Contact telephone number:　　　　　　 　　　

Near relatives notice: