共 页
案由___________________________________
听证时间_________________________________
听证地点_________________________________
听证主持人______________听证员______记录人______
案件承办人________________________________
当事人及委托代理人______________________________________________________________________________________________________
听证记录_____________________________________________________________________________________________________________________________________________________________________________________
注:笔录最后分别由当事人、委托代理人、案件承办人、听证主持人及听证员签名。