<p class="MsoNormal" align="center" style="text-align:center;margin-left:0cm;"> <b><span style="font-size:16px;">法律援助申请表</span><span><span style="font-size:16px;"></span><span style="font-size:16px;"></span></span></b> </p> <p class="MsoNormal" align="left" style="text-align:center;text-indent:-98.8pt;"> 援申字[ ]第<span> </span>号<span></span> </p> <table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="border:none;" align="center"> <tbody> <tr> <td width="560" colspan="26" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" style="text-align:center;"> <b><span style="font-size:14.0pt;font-family:宋体;">申请人基本情况<span></span></span></b> </p> </td> </tr> <tr> <td width="47" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">姓名<span></span></span> </p> </td> <td width="76" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="66" colspan="3" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">性别<span></span></span> </p> </td> <td width="57" colspan="4" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="113" colspan="6" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">出生日期<span></span></span> </p> </td> <td width="76" colspan="4" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="57" colspan="4" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">民族<span></span></span> </p> </td> <td width="69" colspan="3" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="123" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">身份证号<span></span></span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="3" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="27" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="123" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">户籍所在地<span></span></span> </p> </td> <td width="437" colspan="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="123" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">住所地<span></span></span> </p> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;">（经常居住地）<span></span></span> </p> </td> <td width="437" colspan="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="123" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">邮政编码<span></span></span> </p> </td> <td width="142" colspan="8" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="94" colspan="5" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">联系电话<span></span></span> </p> </td> <td width="201" colspan="11" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="123" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">工作单位<span></span></span> </p> </td> <td width="437" colspan="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="560" colspan="26" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" style="margin-left:6.0pt;"> <b><span style="font-size:14.0pt;font-family:宋体;">代理人基本情况<span></span></span></b> </p> </td> </tr> <tr> <td width="123" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">姓名<span></span></span> </p> </td> <td width="145" colspan="9" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="292" colspan="15" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" style="margin-left:5.25pt;"> <span style="font-size:12.0pt;font-family:宋体;">□法定代理人<span> </span>□委托代理人<span></span></span> </p> </td> </tr> <tr> <td width="123" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">身份证号<span></span></span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="3" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="24" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="27" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="560" colspan="26" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <b><span style="font-size:14.0pt;font-family:宋体;">案情及申请理由概述<span></span></span></b> </p> </td> </tr> <tr> <td width="560" colspan="26" valign="top" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <b><span style="font-size:16.0pt;font-family:宋体;"> </span></b> </p> <p class="MsoNormal"> <b><span style="font-size:12.0pt;font-family:宋体;">人承诺以上所填内容和提交的证件、证明材料均真实。<span></span></span></b> </p> <p class="MsoNormal"> <b><span style="font-size:12.0pt;font-family:宋体;"> </span></b> </p> <p class="MsoNormal"> <b><span style="font-size:12.0pt;font-family:宋体;"> </span></b><span style="font-size:12.0pt;font-family:宋体;">申请人（签字）：<span></span></span> </p> <p class="MsoNormal" style="margin-left:231.9pt;text-indent:-231.9pt;"> <b><span style="font-size:12.0pt;font-family:宋体;"> </span></b> </p> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">代理人（签字）：<span></span></span> </p> <p class="MsoNormal"> <b><span style="font-size:12.0pt;font-family:宋体;"> </span></b> </p> <p class="MsoNormal" style="text-indent:11.8pt;"> <b><span style="font-size:12.0pt;font-family:宋体;"> </span></b> </p> <p class="MsoNormal" style="text-indent:264.6pt;"> <span style="font-size:12.0pt;font-family:宋体;"> </span><span style="font-size:12.0pt;font-family:宋体;">年<span> </span>月<span> </span>日<span></span></span> </p> </td> </tr> <tr> <td width="47" style="border:none;"> </td> <td width="76" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="18" style="border:none;"> </td> <td width="6" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="2" style="border:none;"> </td> <td width="19" style="border:none;"> </td> <td width="3" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="19" style="border:none;"> </td> <td width="5" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="22" style="border:none;"> </td> <td width="2" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="6" style="border:none;"> </td> <td width="18" style="border:none;"> </td> <td width="24" style="border:none;"> </td> <td width="27" style="border:none;"> </td> </tr> </tbody> </table> <p class="MsoNormal"> <br /> </p>