Mẫu số: 24
BH theo TT s119/2021/TT-BCA
ngày 08/12/2021
CỘNG HÒA XÃ HỘI CHỦ NGHĨA VIỆT NAM
Độc lập - Tự do - Hạnh phúc
BIÊN BẢN
TIẾP NHẬN NGƯỜI PHẠM TỘI RA TỰ THÚ/ĐẦU THÚ (1)
Hồi .......... giờ ............ ngày............... tháng ............... năm ................................ tại ..........................................................
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Chúng tôi gồm:
Ông/bà: ............................................................................................................................................................................................
Chức danh: ....................................................................................................................................................................................
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Ông/bà: ............................................................................................................................................................................................
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Ông/bà: ............................................................................................................................................................................................
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............................................................................................................................................................................................ người chứng kiến.
Căn cứ Điều 152 Bộ luật Tố tụng nh sự, tiến hành lập biên bản về việc người thực
hiện hành vi phạm tội ra tự thú/đầu thú đối với:
Họ tên: ........................................................................................................................................................... Giới tính:.....................................
n gọi khác: ...........................................................................................................................................................................................
Sinh ngày ............ tháng ........... m ..................... tại: .....................................................................................................................
Quốc tịch: ................................................; Dân tộc: ......................................................; Tôn giáo:
Nghề nghiệp:.............................................................................................................................................................................................
Số CMND/Thẻ CCCD/Hộ chiếu:
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cấp ngày............ tháng ............ năm ................... Nơi cấp: ............................................................................................................
i thường trú: .......................................................................................................................................................................................
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i tạm trú: ................................................................................................................................................................................................
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Nơi hiện tại:
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Nội dung(2):…………………………….....................................................................................................................................................................
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(1) Mẫu ng khi người phạm tội đến tthú hoặc đầu t, quan, tổ chức tiếp nhận phải lập bn bản theo khon 1 Điu 152 BLTTHS;
(2) Ghi tóm tắt diễn biến sự việc, lời khai của người tự thú/đầu thú và những đồ vật, tài liệu thu giữ do người tự thú/đầu thú giao nộp.
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nh trạng sức khỏe của người phạm tội ra tự thú/đầu t(3):
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Việc tiếp nhận người phạm tội ra tự thú/đầu thú kết thúc vào hồi ............. giờ ...............................
ngày............tháng.............năm
Biên bản đã đc cho nhng người có n trên nghe, công nhận đúng và cùng ký tên xác
nhận dưới đây. Biên bản được lập thành hai bản đưa vào hồ sơ vụ án.
NGƯỜI PHẠM TỘI TỰ THÚ/ĐẦU THÚ NGƯỜI LẬP BIÊN BẢN
NGƯỜI CHỨNG KIẾN
(3) Sức khỏe bình thường hoặc có thương tích, bệnh lý.