原告：姓名、性别、出生年月、民族、文化程度、工作单位、职业、住址。

　　（原告如为单位，应写明单位名称、法定代表人姓名及职务、单位地址）

　　被告：姓名、性别、出生年月、民族、文化程度、工作单位、职业、住址。

　　（被告如为单位，应写明单位名称、法定代表人姓名及职务、单位地址）

　　案由：

　　请求事项：（写明向法院起诉所要达到的目的）

　　1.

　　2.

　　事实和理由：（写明起诉或提出主张的事实依据和法律依据，包括证据情况和 证人姓名及联系地址）

　　此致 ______人民法院

　　原告：（签名或盖章）

　　委托代理人：

　　__年__月___日

　　附：一、本诉状副本 份（按被告人数确定份数）； 二、证据 份；

　　三、其他材料 份。

　　注：（１）、诉状用钢笔或毛笔写。

　　（２）、“当事人”栏，均应写明姓名、性别、出生年月日、民族、籍贯、职业或工作单位和职务、住址等项。对被告人的出生年月日确实不知的，可写明其年龄。

　　（３）、“案由和诉讼请求”栏，应写明控告的罪名和具体的诉讼要求。

　　（４）、“事实与理由”部分的空格不够用时，可增加中页。

　　（５）、诉状副本份数，应按被告人的人数提交。

　　To：________________ People's Court

　　Plaintiff：

　　Domicile：

　　Legal Representative：

　　Position：

　　Defendant：

　　Domicile：

　　Legal Representative：

　　Position：

　　CLAIMS：

　　1. To order the Defendant to pay to the Plaintiff the due amount of RMB _____ for the dispatched products, plus the interests of RMB ________ thereon, in the aggregate of RMB __________；

　　2.To order the court fees to be borne by the Defendant.

　　FACTS AND REASONS：

　　The Defendant was one of the distributors of the Plaintiff for various kinds of products in the territory of ___________, China. From September, 1997 to October, 1998, the Plaintiff dispatched various kinds of products in the aggregate values of RMB ____________. （see Exhibit I）

　　Each of the said transactions was duly signed and received by the Defendant （see Exhibit II）. Though the Plaintiff has repeatedly demanded payment, the Defendant fails to liquidate the outstanding debts in due time.

　　It is the Plaintiff's position that the indebtedness arising out of the transactions between the Plaintiff and the Defendant shall be under the jurisdiction of the Chinas laws. The Defendant's refusal to satisfy the agreed amounts after receipt of the above-mentioned lubricants resulted in tremendous economic losses on the side of the Plaintiff （see Exhibit III）. Therefore, pursuant to the relevant PRC laws and regulations, the Defendant shall assume the civil liabilities accordingly for such nonpayment.

　　By reason of the forgoing, in accordance with Articles 106 and 112 as set forth in the PRC General Civil Law, Article 108 as set forth in the PRC Civil Procedural Law and other applicable laws and regulations, the Plaintiff hereby files this case with the Court for your adjudication.

　　Plaintiff：

　　Date：

　　ATTACHMENTS：

　　1. One copy of the Plaintiff's business license；

　　2. One copy of the original Certificate of the Legal Representative；

　　3. One copy of the original Power of Attorney；

　　4. Exhibit I： Invoices for each transaction；

　　5. Exhibit II： Receipts for each transaction； and

　　6. Exhibit III： List of Losses.