「報件評估表」

 

性別：           年齡：            職業：             

 

1.案件事故經過

                                                        

                                                        

2.送醫過程經過

                                                                 

                                                                  

3.現況傷勢

                                                                     

                                                               

4.過程中遇到的困難

                                                          

                                                            

5.當事人的目標金額

                                                          

 

6.現有文件(影本即可)

 

□ 診斷書                □ 收入證明           

□ 事故聯單   「車禍」     □現場圖      「車禍」

□ 初判表     「車禍」      □ 鑑定意見書  「車禍」

下載表單pg

填寫下列表格立即評估