襄阳市工伤认定申请书
申请人：_____________________________________________________________单位名称：___________________________________________________________单位地址：___________________________________邮政编码：_______________单位法定代表人：____________________________单位电话：_______________事故发生时间：_______________________________________________________事故发生地点：_______________________________________________________事故发生过程：____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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证人1：（姓名、与受伤人关系）_________________________________
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