申请人:______________
申请人与 因 一案,已于 年 月 日向你院提起诉讼。现因该案 即将灭失(或者是以后难以取得),为此,申请给予保全证据。现将案情事实、理由和具体请求目的分述如下:
事实和理由:______________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
请求目的:_______________________________________________________________________________________________________
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此致
________人民法院
申请人:__________
____年____月____日