申诉人__________________________________ 联系方式_____________________________________
委托代理人______________________________ 联系方式_____________________________________
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对方当事人____________________________________________________________________________
________________________________________ 联系方式_____________________________________
申诉请求______________________________________________________________________________
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事实和理由____________________________________________________________________________
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此致
_____________人民检察院
年 月 日
申诉人签名(盖章):
附证据材料:
民事(行政)案件申诉书制作说明
一、本文书依据最高人民检察院《人民检察院民事行政抗诉案件办案规则》第五条的规定制作。为公民、法人或其他组织不服人民法院生效裁判向人民检察院申诉时使用。
二、法人或其他组织申诉时,除填写本文书外,还应填写“法定代表人资格证时书”。申诉人委托代理人的,还应填写“授权委托书”。