第 页 共 页
谈话时间_____年_____月_____日_____时_____分至_____年_____月_____日_____时_____分
谈话地点 :_____________________________________________________________________
谈话人 :_____________________________ 工作单位:_______________________________
记录人 :_____________________________ 工作单位:_______________________________
被谈话人姓名 :_________________性别:__________ 年龄:_________ 国籍:_________
工作单位及联系电话:____________________________________________________________
住址:__________________________________________________________________________
翻译人员姓名:____________________________________ 联系电话:_________________
工作单位或住址:________________________________________________________________
谈话记录如下:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
____________________________________________________________________________
签名:_______________