XLS《待遇审批》

"工伤(亡)职工待遇审批表" "单位名称(印章) "姓名",,

,"性别",,

"年龄",,

"身份证号",,

,,

,,

"工伤(亡)职工照片", "工伤(亡)发生时间",,

,,

"伤残部位","",,

"社会保障号",,

,,

,,

, "工伤(亡)认定时间",,

"",,

"首次劳动能力鉴定时间",,

"","再次劳动能力鉴定时间",,

,,

,,

, "护理等级鉴定时间",,

,,

"复查劳动能力鉴定时间",,

,"首次鉴定结论",,

,,

,,

, "再次鉴定结论",,

,,

"复查鉴定结论",,

,"工伤(亡)认定书文号",,

,,

,"护理等级鉴定结论",,

"本人月缴费工资",,

,,

"郑州市上年度职工月平均工资"劳动能力鉴定费",,

, "伤残待遇","定期伤残待遇",,

,,

,,

"一次性伤残补助金",,

,,

,,

"小计", ,"伤残津贴",,

"护理费",,

"伤残津贴与 养老金差额",,

"核发月数",,

,,

"金额",,

, "工亡待遇","因工死亡",,

,,

"停工留薪期内死亡",,

,,

,"停工留薪期满死亡",,

,,

,"一次性工亡补助金",,

,,

,"丧葬费"小计", ,"上年度全国城镇居民人均可支配收入",,

,"金额",,

"核发月数",,

,,

"金额",,

,,

,"供养直系亲属姓名","性别","出生年月","与死者关系","供养原因","户口所在地",,

"抚恤金标准",,

,"供养亲属照片1",,

"供养亲属照片2", 供养亲属照片3",,

"供养亲属照片4", ,"小计" "补发起止时间: "工伤(亡)保险待遇合计(大写) "参保单位",,

,"经办机构(印章) "经办人:",,

,"经办人:",,

," 复核人:",,

,,

,"审批人:",,

, "注:此表一份报工伤保险待遇处.

年月日",,

,,

"工伤职工一次性工伤医疗补助金待遇审批表" "单位名称(印章) "姓名",,

,"性别",,

,"身份证号"工伤职工照片", "工伤发生时间",,

,,

,"工伤认定时间" "工伤认定书文号" "伤残部位" "最终或最高劳动能力鉴定时间",,

,,

,,

"最终或最高劳动能力鉴定结论" "解除或终止劳动关系时间",,

,,

,,

"解除或终止劳动关系时郑州市上年度职工月平均工资" "计发月数",,

,,

,,

"职业病增发数额" "一次性工伤医疗补助金待遇合计(大写) "参保单位",,

,"经办机构(印章) "经办人:",,

,"经办人:",,

," 复核人:",,

,,

,"审批人:",,

, "注:此表一式三份,工伤保险经办机构二份,用人单位一份. 年月日",,

,,