[대기중]Kiddies, Work and 카지노
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21 2023.07.28 14:39
신청인
성명 | Chastity | 피해자와의 관계 | |
---|---|---|---|
연락처 | 이메일 | chastity.castleton@sfr.fr |
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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