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["工 伤 申 报 证 据 清 单"]
["编号","证    据    名    称",null,"是否\n原件","页数"]
["01","工伤认定申请（表）",null,"是","2"]
["02","受伤职工身份证、社会保障卡、居住证",null,"否","1"]
["03","初诊病史（病历、出院小结、拍片报告）",null,"否"]
["04","劳动关系相关证明","□劳动关系证明"]
["05",null,"□劳动合同"]
["06",null,"□考勤卡□工作证□胸卡等"]
["07",null,"□工资明细单□工资条□工资卡等"]
["08",null,"□劳务派遣证明"]
["09","事故证明","□单位事故证明或事故报告"]
["10",null,"□证人证言"]
["11",null,"□证人身份证"]
["12","交通事故相关证明","□交通事故认定书"]
["13",null,"□上下班路线图"]
["14",null,"□上下班时间证明□考勤记录"]
["15",null,"□租房证明□租房协议"]
["16",null,"□房东身份证"]
["17","其他有关证明材料"]
["18"]
["19"]
["20"]
["证据提交人：                          经办人签收：                    a"]
["年      月      日                      年      月      日"]

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