刑事委任代理書

刑事委任代理書

委任人（被害人）：
身分證字號：
住址：

受任人（代理人）：
身分證字號：
住址：
電話：

委任事由：
針對「長生養老院」照護人員涉嫌”傷害罪”（刑法第277條）及”遺棄罪”（刑法第294條）案件，
委任人現委託受任人為代理人，全權處理刑事告訴及相關程序 。

一、 刑事告訴代理：
受任人有權代為提出刑事告訴、陳述意見、參與筆錄，
並針對被告一（外籍看護）及被告二（值班護理師）之犯罪行為進行追究 。

二、 證據保全申請：
扣押監視影像：請求警方扣押114年12月27日長生養老院之全日監視畫面 。
調閱出勤紀錄：請求調閱119救護員證詞，以證明傷口為「整齊切割傷」。
傳喚相關證人：請求傳喚當日值班護理師及國軍替代役男到案說明 。

三、 特別聲明：
拒絕調解：本案涉及長者受虐與人身安全，委任人嚴正拒絕進行調解，請逕行移送檢察署偵辦 。
加重其刑：委任人為雙目失明之重度身心障礙者 ，被告等欺凌無自救能力之人，
建請依《老人福利法》及相關法律加重其刑 。

此致
台中市政府警察局（第二分局/育才派出所）

委任人： ________

受任人： ________

中華民國 115 年 1 月 26 日

Criminal Authorization Letter

Principal (Victim):
ID Number:
Address:

Agent (Representative):
ID Number:
Address:
Telephone:

Reason for Authorization: Regarding the case involving caregivers of “Chang Sheng Nursing Home” suspected of “assault” (Article 277 of the Criminal Code) and “abandonment” (Article 294 of the Criminal Code),

the Principal hereby authorizes the Agent as their representative to handle all criminal complaints and related procedures.

I. Criminal Complaint Representation:

The Agent has the right to file criminal complaints, state opinions, participate in the recording of statements,

and to pursue the criminal acts of Defendant 1 (foreign caregiver) and Defendant 2 (on-duty nurse).

II. Application for Evidence Preservation:

Seizure of Surveillance Footage: Requesting the police to seize the full-day surveillance footage of Chang Sheng Nursing Home dated December 27, 2025.

Request to review duty records: Request to review the testimonies of the 119 emergency medical personnel to prove the wound was a “clean cut”.

Request to summon relevant witnesses: Request to summon the nurse on duty that day and the military alternative service member to appear for questioning.

III. Special Statement:

Refusal to mediate: This case involves abuse of the elderly and personal safety. The appointee firmly refuses to mediate and requests that the case be transferred directly to the prosecutor’s office for investigation.

Aggravated punishment: The appointee is a severely disabled person who is blind in both eyes. The defendants bullied someone who was unable to help themselves.

It is recommended that their punishment be increased in accordance with the Elderly Welfare Act and related laws.

Respectfully submitted to:

Taichung City Police Department (Second Precinct/Yucai Police Station)

Appointor: ________

Recipient: ________

January 26, 2016 (Republic of China Year 115)