Mẫu số: 16

Ban hành kèm theo Thông tư số 61/2017/TT-BCA ngày 14/12/2017 của Bộ Công An 


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 ......................................

...............................................................................................................................................................................................................

Chúng tôi gồm:

Ông/bà: ..............................................................................................................................................................................

Chức vụ: .........................................................................................................................................................................................                

Ông/bà: ..............................................................................................................................................................................

...............................................................................................................................................................................................................

Ông/bà: ..............................................................................................................................................................................

...............................................................................................................................................................................................................

............................................................................................................................................................................................ là người chứng kiến.

Căn cứ Điều 152 Bộ luật Tố tụng hình 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:.......                

Tên gọi khác: ..............................................................................................................................................................................                

Sinh ngày ............ tháng ........... năm ..................... tại: .....................................................................................................                

Quốc tịch: ................................................; Dân tộc: ......................................................; Tôn giáo:.............................                

Nghề nghiệp:                                                                                                                                                                                                

Số CMND/Thẻ CCCD/Hộ chiếu:...................................................................................................................................                

cấp ngày............ tháng ............ năm ................... Nơi cấp: .............................................................................................                

Nơi cư trú: .......... .........................................................................................................................................................................

...............................................................................................................................................................................................................                                 ............................................................................................................................................................................................

 (2).........................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

 

 

 
 
 

(1) Mẫu dùng khi người phạm tội đến tự thú hoặc đầu thú, cơ quan, tổ chức tiếp nhận phải lập biên bản theo khoản 1 Điều 152 BLTTHS;

(2) Nội dung: Ghi tóm tắt diễn biến sự việc, lời khai của người tự thú/đầu thú và những đồ vật, tài liệu thu giữ; nếu là đồ vật, tài liệu cần niêm phong thì phải niêm phong tại chỗ và ghi vào biên bản.

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................                

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

Tình trạng sức khỏe của người phạm tội ra tự thú/đầu thú(3):

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

...............................................................................................................................................................................................................

Việc tiếp nhận người phạm tội ra tự thú/đầu thú kết thúc vào hồi ............. giờ ............................... ngày............tháng.............năm ..................................................................................................................................................                    

Biên bản đã đọc cho những người có tên 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.

Tiếng Việt

Đây là văn bản biểu mẫu do Công ty tự soạn thảo, nếu Anh/Chị muốn sử dụng dịch vụ vui lòng liên lạc với chúng tôi để được nâng cấp tài khoản VIP. Xin cám ơn.

English

Đây là văn bản biểu mẫu do Công ty tự soạn thảo, nếu Anh/Chị muốn sử dụng dịch vụ vui lòng liên lạc với chúng tôi để được nâng cấp tài khoản VIP. Xin cám ơn.

Hướng dẫn

Biểu mẫu

Hỏi đáp

Biểu mẫu công vụ

Nếu bạn thấy văn bản này có dấu hiệu vi phạm, vui lòng gửi thông báo cho chúng tôi. Chúng tôi sẽ xem xét và xử lý văn bản này trong thời gian sớm nhất.