质疑函范本

（采购人或代理机构名称）：

一、质疑供应商基本信息

质疑供应商：                                        

地址：                          邮编：                                                   

联系人：                      联系电话：                              

授权代表：                                          

联系电话：                                            

地址：                         邮编：                                                

二、质疑项目基本情况

质疑项目的名称：                                      

质疑项目的编号：               包号：                 

采购人名称：                                         

采购文件获取日期：                                           

三、质疑事项具体内容

质疑事项1：                                         

事实依据：                                          

法律依据：                                          

质疑事项2

事实依据：                                          

法律依据：                                          

……

四、与质疑事项相关的质疑请求

请求：                                               

签字(签章)：            公章：             日期：