فرم قضایی : شکواییه مزاحمت تلفنی

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در بخش موضوع  می نویسید:
مزاحمت تلفنی

در بخش خلاصه اظهارات  می نویسید:

با عرض سلام و تحیت احتراماً به استحضار عالی می‌رساند:
اینجانب ……………. مالک خط تلفن به شماره ……………… می‌باشم. مشتکی‌عنه ……………. از طریق شماره‌های ……………. برای بنده ایجاد مزاحمت تلفنی کرده است.
ذکر این نکته لازم است که مشتکی‌عنه، با شماره‌های ذکر شده در بند فوق، از تاریخ ………….. به مدت …………. ماه با شماره بنده تماس گرفته و مزاحمت ایجاد می‌کردند.
با وجود اینکه اینجانب بارها مؤدبانه از ایشان درخواست کرده‌ام که دیگر مزاحم بنده نشوند، اما متاسفانه وی به کار خود ادامه دادند. مشتکی‌عنه علاوه بر تماس‌های تلفنی با ارسال پیامک‌های غیر اخلاقی موجب آزار و سلب آسایش بنده شده‌اند، که لیست تماس‌ها و پیامک‌های ایشان گواه این مدعا است.
لازم است یادآوری شود که در مورخ …………….. بنا به درخواست اینجانب، اخطاری از سمت شرکت مخابرات برای ایشان ارسال شد که این اقدام نیز بی‌فایده بوده است.
لذا با عنایت به شرح موضوع با کیفیت فوق و با توجه به ادله اینجانبه شامل: 1- لیست تماس‌ها 2- …………………….. و با توجه به اینکه فعل ارتکابی مشتکی‌عنه از مصادیق بارز ماده 641 قانون مجازات اسلامی (تعزیزات و مجازات‌های بازدارنده) می‌باشد، تعقیب و مجازات ایشان به اتهام مزاحمت تلفنی، مورد استدعاست. قبلاً از بذل عنایت جنابعالی کمال تشکر را دارد.
همچنین با توجه به خسارات وارده به اینجانبه که مبلغ …………… است، بدواً تقاضای صدور و اجرای فوری تأمین خواسته را دارم.

تهیه شده در سامانه ملی قوانین و مقررات جمهوری اسلامی ایران
به قلم : دکتر حشمدار

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