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证 据 保 全 申 请 书
申请人：姓名，性别，年龄，民族，籍贯，职业或职务，单位或住址。
申请事项:请求人民法院依法对___________________________(证据名称)采取保全措施.
事 实 和 理 由
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证据线索和存放地址
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此致
_________人民法院
申请人：___________
(签名或盖章)
_____年____月____日 | 
