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。
