(๗)

คํารอง / คําแถลง / คําขอ

คดีหมายเลขดําที่ ................./๒๕............
คดีหมายเลขแดง.................../๒๕............
ศาล .........................................................................
วันที่............เดือน.................................. พุทธศักราช ๒๕...........
ความ ................................................................................

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โจทก
ระหวาง
............................................................................................................................. จําเลย
ขาพเจา ............................................................................................................................
เลขประจําตัวประชาชน ----
เชื้อชาติ...................สัญชาติ................อาชีพ..............................เกิดวันที่…...…เดือน………….......พ.ศ.………..
อายุ............ป อยูบานเลขที่.........................หมูที่...............ถนน....................................................................
ตรอก/ซอย.......................................ตําบล/แขวง..................................อําเภอ/เขต.......................................
จังหวัด..................................................รหัสไปรษณีย. .........................โทรศัพท.............................................
โทรสาร……………….………….................…... ไปรษณียอิเล็กทรอนิกส ….................................................……….
ขอยื่นคํารอง / คําแถลง / คําขอ มีขอความตามที่จะกลาวตอไปนี้
ขอ ๑....…………………………………………………………..................................................…………..
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หมายเหตุ ขาพเจารอฟงคําสั่งอยู ถาไมรอใหถือวาทราบแลว

..................................................... ผูรอง / ผูแถลง / ผูขอ

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