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Application for disability level

Dear leaders

My name is XXX. How old am I? I joined the army in a certain month and year. On a certain day and year, I had an accident (write down the reason) when I was performing the task assigned by the leader. I was diagnosed with several levels of disability in the hospital. After careful treatment by medical staff, he was discharged from the hospital on a certain date to resume recuperation at home. But the postoperative symptoms did not improve completely.

Please assess your disability according to the disability assessment standards.

Sincerely

__________People's Court

Applicant:________________

_____Date:

Application for disability level