Victim [signature]

Before the start, during, or upon completion of the interrogation of the victim___, from the participating persons

(their procedural status, surnames, initials)
statements: none were received. Content of statement: _____
(received, did not receive)

[Z-shaped strike-through]

Victim [signature]

Other participating persons:
____ (signature)
______ (signature)

Protocol read personally
(personally or aloud by the investigator (inquirer))

Comments on the protocol: none
(content of comments or indication of their absence)

Victim [signature]

Other participating persons:
____ (signature)
______ (signature)

Investigator (inquirer) [signature]