十六、抚恤金（丧葬费）申请表.doc

<p>抚恤金（丧葬费）申请表
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
申
请
人
姓
名

性

别

籍

贯

年

龄

与死者关系

证 字 号
地址身份

死亡人姓 &nbsp; 名

性别

籍贯

年龄
岁
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;年 &nbsp; 月 &nbsp; 日止
到职日期

服务
部门

职称

工资

死亡日期

死亡
原因

死亡原因与执
行公务的关系

有无
劳保

请发金额
美金 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 万 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;仟 &nbsp; &nbsp; &nbsp; &nbsp; 佰 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 拾 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;元正
抚恤费
丧葬费
总经理或
董事长

经
理

人事主管

部门主管

申请人

&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;附注：应附缴全户户籍联本一份，死亡证明书一份及保证书 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;

申请 &nbsp; &nbsp; &nbsp; &nbsp; 保证书

抚恤金
丧葬费
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 保证人 &nbsp; 今保证 &nbsp; &nbsp; 先生（女士）等确系 &nbsp; &nbsp; &nbsp; &nbsp;贵公司故 &nbsp; &nbsp; &nbsp; &nbsp;先生之遗属依国家法规 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 之规定顺序，具有最优先资格，申领 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;贵公司发给 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; ，若有不符情况，致使贵公司遭受损害时，保证人应立即赔偿
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 一切损失， &nbsp; 并抛弃先诉抗辩权。
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 此致
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 公司
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;保 &nbsp;证 &nbsp;人
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;身份证字号
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;住 &nbsp; &nbsp; &nbsp;址 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 年 &nbsp; 月 &nbsp; &nbsp;日</p>