统计局

调  查  笔  录

调查时间：   年    月    日  时   分至    时    分   第      次

地点：                                                       

被调查人：姓名              性别               职务            

工作单位：                           联系电话                  

地址：                                                         

调查人：                               记录人：                

                                                               

                                                              

                                                               

                                                              

                                                               

                                                              

                                                                

                                                              

                                                              

                                                              

                                                                

                                                              

                                                               

                                                              

                                                               

被调查人签名：

第    页（共  页）

                                                              

                                                              

                                                               

                                                               

                                                              

                                                               

                                                              

                                                               

                                                               

                                                              

                                                              

                                                               

                                                               

                                                              

                                                               

                                                               

                                                              

                                                              

                                                               

                                                               

                                                               

                                                              

                                                              

被调查人签名：

第    页（共  页）