80-非因工伤病劳动能力鉴定申请表（80- application form for labor capacity assessment for non occupational injuries）.doc

80-非因工伤病劳动能力鉴定申请表（80- application form for labor capacity assessment for non occupational injuries） Not because of the identification ability of labor injury disease application Shenzhen Municipal Committee of labor ability appraisal Injury (get): age: sex: ID number: personal social security number: Disease: diagnosis time: Unit: Now apply for identification. Signature of applicant: (or seal) Specific date Application notes: 1. for identification of labor ability of units required to submit orders or labor relationship certificate (or terminate the labor relationship certificate);. 2. for the identification of Bingtui is required to submit a written application and stamped with the official seal (no units to the personal files where the seal, no file or files kept by individual to local residents committee seal);. 3. applicant and the identification of the original and photocopy of an identity card;. 4. submission and identification of relevant original medical records (including inspection report) and copy;. 5. people submitted identified three recent one inch bareheaded color photos. . Post send give reach . Unit name: telephone number: Mailing address: post encoding: The identified person: Telephone: post encoding: Mailing address: Note: if the applicant or fill in the wrong address unknown cause identification conclusion cannot be effectively served as the appraisal conclusion Have been served. Signature of Applicant: sealed units: since Thats ok collar take . Note: the applicant was identified by the identification or receive notice and identity card, according to the specified time to Shenzhen city labor ability appraisal business office window to receive the identification conclusion; The uncollected as a service; The commissioned behalf shall be issued orders and valid documents. Signature of Applicant: sealed units: Choose the conclusion of work capability assessment service Not because of the identification ability of labor injury disease application Shen