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            首頁> 法律文書 > 賠償訴訟> 工傷認定申請書

            工傷認定申請書

            賠償訴訟 2019-01-08 02:05:02 4248人閱讀 律師365
            申請人:×××,男,××年××月×日出生,漢族,籍貫,住×××市×××街,是××公司職工。

            被告:××公司,地址:×××××××

            法定代表人:×××任××職務

            聯系電話:××××××


            請求事項

            請求勞動部門依法認定申請人在×××時間受傷為工傷。


            事實及理由:
            申請人是×××公司職工,××××年××月被招入公司,擔任××工作,在××年月日上班時間,因為公司發生××工作事故,致使申請人受到嚴重傷害。申請人受傷后,在××市××醫院住院治療,現已治療×個月,花費醫藥費××元。

            根據《工傷保險條例》的規定,特申請勞動部門對申請人受傷一事進行調查核實,并依法認定本人此次受傷為工傷。

            此致

            ××縣(市)勞動保險部門

            申請人(簽字):××



            2004年1月25日 

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