Criminal incidental civil action, the criminal part does not appeal, how to write the appeal of the civil part?

Criminal incidental civil appeal

Appellant (plaintiff in criminal incidental civil case of first instance): Basic information.

The basic information of the appellee (defendant in the original trial) is now detained in XX detention center.

The appellant refuses to accept the criminal incidental civil judgment () Chu Zi No.,and appeals to your hospital. Xx made by the people's court of xxx.

Appeal request

Request the court of appeal to change the judgment of the people's court of xxx (), item X of the criminal incidental civil judgment, and change the judgment of xxxx according to law.

Facts and reasons

I am here to convey

XXXX people's court

Appellant:

Date, year and month