Disability identification application

Xx traffic police detachment:

My name is xxx, male, xx years old, live: xxxxxxxxx.

This year x month x day x when x points, I was injured by a xx car in xx street xx, diagnosed by xx city people's hospital: 1, xxxx; 2, xxxx, through xx days of treatment, now xx still Xx, the disability will not be recoverable within xx years, and the application for disability identification will be filed with the xx traffic police detachment.

Application content: 1, xxx disability level.

2, the degree of care dependence.

Applicant: xxx

Xxxx year x month x day