2. Payment Form Template
Payment application form
Applicant * * Application Department * * Application Date * *
Payment method * * (cash or transfer) Payment time * *
Application for work-related injury treatment fee
Total amount (in words) * * RMB in figures.
Payee's name * *
Payee account number * *
Payee's bank * *
Invoice issuance time * *
General Manager: Financial Audit: Department Manager:
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Article 38 The following expenses incurred due to work-related injuries shall be paid by the work-related injury insurance fund in accordance with state regulations:
(a) medical expenses and rehabilitation expenses for the treatment of work-related injuries;
(2) Hospitalization food subsidies;
(three) transportation and accommodation expenses for medical treatment outside the overall planning area;
(four) the cost of installing and configuring assistive devices for the disabled;
(five) life can not take care of themselves, confirmed by the labor ability appraisal committee of life care costs;
(6) One-time disability allowance and monthly disability allowance for disabled employees of Grade I to IV;
(seven) the one-time medical subsidy that should be enjoyed when the labor contract is terminated or dissolved;
(8) Funeral grants, dependent relatives' pensions and work-related death grants received by survivors of work-related deaths;
(nine) labor ability appraisal fee.
Article 39 The following expenses incurred due to work-related injuries shall be paid by the employing unit in accordance with state regulations:
(a) wages and benefits during the treatment of work-related injuries;
(two) the monthly disability allowance for disabled employees of Grade 5 and Grade 6;
(3) One-time disability employment subsidy that should be enjoyed when the labor contract is terminated or dissolved.