CUMHURİYET BAŞSAVCILIĞINA

                                     KARŞIYAKA

 

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TC KİMLİK  NO       : ........................................................................................................................

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MESLEĞİ                  : ........................................................................................................................

ADRESİ                    : ........................................................................................................................

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TELEFONU              : ........................................................................................................................

ŞİKAYET OLUNAN : ...................................................................................................................

(Adı-Adresi-Telefonu)........................................................................................................................

SUÇ                           : ........................................................................................................................

SUÇ TARİHİ            : ........................................................................................................................

SUÇ YERİ                 : ........................................................................................................................

CEP TELEFONUNUN MARKASI VE MODELİ:............................................................................

CEP TELEFONUNUN İMEİ NUMARASI          :.............................................................................

CEP TELEFONUNUN HAT NUMARASI          :.............................................................................

CEP TELEFONUNUN FATURASININ BULUNUP-BULUNMADIĞI:.........................................

AÇIKLAMA             : ........................................................................................................................

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                                   5809 SAYILI ELEKTRONİK HABERLEŞME KANUNU'NUN 57 VE 58. MADDELERİ UYARINCA SUÇA KONU CEP TELEFONUMUN UYAP ORTAMINDA ELEKTRONİK HABERLEŞME BAĞLANTISININ KESİLMESİNİ VE GÖRÜŞMEYE KAPATILMASINI İSTİYORUM.

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