How to do the work-related injury insurance wage declaration form

Legal analysis: the applicant can fill in the following form: 1, the name of the company, and affix the official seal; 2. Unit code (on the copy of business license); 3. Fill in the name, gender, date of birth, ID number, time of work injury, end of medical treatment, time of disability appraisal and disability grade truthfully; 4, social security code (social security code on the back of the injured social security card); 5. Number of disability appraisal table (see the upper right corner of appraisal conclusion); 6, the wages of employees truthfully fill in; 7. Signature of the unit manager.

Legal basis: Article 18 of the Regulations on Work-related Injury Insurance shall submit the following materials when applying for work-related injury identification: (1) An application form for work-related injury identification; (two) the existence of labor relations with the employer (including factual labor relations); (3) Medical diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis certificate). The application form for ascertainment of a work-related injury shall include basic information such as the time, place and cause of the accident and the degree of injury of the employees. If the materials provided by the applicant for work-related injury identification are incomplete, the social insurance administrative department shall inform the applicant in writing of all the materials that need to be supplemented at one time. The administrative department of social insurance shall accept the corrected materials after the applicant has been informed in writing.