Applicant: Wu Wang, ID number:.

Application: disability grade appraisal

When the applicant went to XX hospital for toe plastic surgery in XX month, a medical accident occurred in the hospital, resulting in the amputation of two toes of the applicant. We now apply for forensic experts to identify the above injuries of the applicant.

I am here to convey

XX people's court

Applicant: Wu Wang.

XX year x month x day