[대기중]The Secret History Of Status
페이지 정보
19 2023.08.22 23:09
신청인
| 성명 | Jana | 피해자와의 관계 | |
|---|---|---|---|
| 연락처 | 이메일 | janajudkins@gmail.com |
피해자
| 성명 | 성별 | 남자 | |
|---|---|---|---|
| 피해자 생년월일 | 년 월 일 | 사고발생일 | 년 월 일 |
| 입원기간 | 개월 | 월소득 | 만원 |
| 진단명 | 피해자과실 | ||
| 후유장해 | 향후치료비 | 만원 | |
| 개호비 | 만원 | 형사합의금 or 공탁금 |
만원 |
본문
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