Isn’t it time to find a template for workers’ compensation agreement? Below is the "Eleven Selected Work Injury Compensation Agreement Sample Samples" compiled by me for your reference only. You are welcome to read this article. Work Injury Compensation Agreement Sample Part 1

Party A: ______________ Co., Ltd., address: _________ Industrial Park _________ Factory

Party B: _________, male, ID number: ______________ , Address: ___________

Party A and Party B are now seeking compensation for a work-related injury that occurred while Party B was working at the _________ factory. After being mediated by the _____ People’s Mediation Committee, both parties reached an agreement on a voluntary and equal basis through consultation. The following agreement has been reached:

1. Party B suffered a work-related injury while working at Party A’s company on _____month_____, 20_____, causing the first and second toes of Party B’s left foot to break. Later, Party A promptly sent Party B to _____ Hospital for treatment. During the treatment, Party A paid all expenses (including medical expenses) for the treatment of the work-related injury, and the patient has now recovered and been discharged.

2. Party B now requires Party A to compensate it for the above-mentioned work-related injury accident and submit an application for resignation. After consensus, both parties agree to Party B's resignation application, confirm the termination of the labor relationship with Party B, and Party A will pay Party B a one-time work-related injury compensation (including subsequent medical expenses, work-related injury and disability subsidies, one-time medical and employment subsidies, Wages, nursing fees, economic compensation and other expenses during the period of work-related injuries)*** totaling RMB 20,000.00 (lowercase: ￥29,000.00 yuan), in order to end all rights and obligations between the two parties regarding compensation for work-related injuries and give up pursuit. All legal responsibilities of Party A.

3. Party A shall pay the above compensation fee to Party B in one lump sum (in cash) on the date of signing this agreement.

4. This agreement shall take effect from the date of signature by Party A and Party B. From the date of signing this Agreement, Party B shall not claim any additional rights regarding the above compensation issues, and Party A will no longer assume any obligations. If Party B violates the above agreement and causes losses to Party A, Party A will hold Party B accountable for compensation according to law.

5. This agreement is made in triplicate, with Party A and Party B each holding one copy, and the People's Mediation Committee of ____ keeping one copy, all of which have the same legal effect. < /p>

Part 2 of the Sample Work Injury Compensation Agreement on _____month_____day, 20_____

Employer:

Employee: , ID number: , Telephone: According to the "Labor Law of the People's Republic of China", "Labor Contract Law of the People's Republic of China", "Labor Dispute Mediation and Arbitration Law of the People's Republic of China", "Work-related Injury Insurance Regulations" and other laws According to the provisions of laws and regulations, the employer and the employee, on the basis of equality and voluntariness, have reached the following agreement on the matter of employee disability compensation, and shall jointly abide by and perform it.

Article 1: Around ____ hour on _____ month _____ day _____ year _____, _____ was doing ___________ work at __________, when _______________ occurred.

Article 2 After full negotiation between the two parties, the employee agrees to give up the right to apply for work-related injury and disability assessment, and the employer shall provide the employee with corresponding one-time compensation in accordance with relevant standards.

Article 3 After full negotiation between the employer and the employee, the employee agrees that the employer will provide him with the following work-related injury benefits:

(1) Medical expenses and follow-up treatment expenses are: :___5,000 yuan (rounded to the nearest five thousand)_______;

(2) Lost work allowance (including the medical period and the recovery period after discharge) is: 45,000 yuan (rounded to the round of four to five thousand)_______;

(3) Other expenses (including hospitalization food subsidy, nursing fee, one-time disability subsidy, one-time disability medical subsidy, one-time disability employment subsidy, etc.) are: ____10,000 yuan (one

(4) The aforementioned expenses are calculated in RMB: ____60,000 yuan (millions of yuan)___________.

For the compensation agreed in the preceding paragraph, Party A shall pay the employee in full within 10 days from the effective date of this agreement without delay; the employee shall receive the compensation himself and shall not entrust others to receive it on his behalf. , if entrusting another person, a notarized power of attorney should be provided.

Article 4 Starting from _____ month _____, year _____, the labor contract relationship between the employer and the employee will be terminated, and all social insurance relationships will also be terminated at the same time. There are no other creditor's rights or debt relationships between them. Employees shall go through the relevant procedures for terminating the labor relationship within 3 days from the date of entry into force of this agreement.

Article 5 After this agreement comes into effect, the employee agrees not to make any claim for compensation from the employer for any reason. If the employee violates the terms of this agreement, he agrees to forfeit any compensation that has been collected. The aforementioned compensation fees will be fully refunded to the employer.

Article 6 This agreement will take effect from the date of signature by both parties.

Article 7 This agreement is made in quadruplicate, with the employer holding three copies and the employee holding one copy, which have the same legal effect.

Article 8 Any dispute arising from this agreement shall be arbitrated by the labor dispute arbitration committee where the employer is located.

Article 9 This agreement is signed in Party A’s office on _____ month _____ day _____ year.

Employer (seal): _____ Employee (signature):

Person in charge (signature): Work Injury Compensation Agreement Sample Part 3

Party A: __________

Party B: __________ ID number: __________

Party B is an employee of Party A. During the period of work on _____ month _____ day _____ year An injury occurred, which was later identified as a work-related injury by the __________ Municipal Labor and Social Security Bureau, and as a grade-level disability by the __________ Municipal Labor Ability Appraisal Committee. Now Party B and Party A have reached an agreement through negotiation on compensation for their injuries, and this association will prepare this mediation agreement in accordance with the provisions of Article 14 of the Labor Dispute Arbitration and Mediation Law:

1. A Party B has participated in social security for Party B, and the social security fund will pay Party B’s medical expenses and one-time disability subsidy. In addition, while Party B is injured and resting, Party A will continue to pay his salary every month.

2. Party A and Party B have reached an agreement that Party B will continue to work for Party A, and Party A will pay Party B’s one-time disability employment subsidy and one-time work-related injury medical subsidy in advance when he leaves the company. shall be paid to Party B. Party B shall not make any further requests for one-time disability employment subsidies and one-time work-related injury medical benefits when resigning. According to the relevant provisions of the "Regulations on Work-related Injury Insurance of Guangdong Province", the two parties negotiate that Party A pays RMB _____ yuan [capitalized _____] to Party B (this payment includes all work-related injury benefits stipulated in the "Regulations on Work-related Injury Insurance of Guangdong Province": All work-related injury insurance benefits such as the difference in one-time disability subsidy, one-time disability employment subsidy, one-time work-related injury treatment subsidy, and the period of suspension of work and salary). After Party B receives this amount, Party B shall not pursue any other claims from Party A. any fees. Otherwise, if Party A's production and operation are affected and Party A's losses are caused, Party B shall compensate.

3. Party B must issue a receipt when collecting the above compensation.

4. This agreement was signed by Party A and Party B on the basis of equality and voluntariness. It represents the true intention of both parties and neither party has been coerced.

5. According to the provisions of Article 14 of the "Labor Dispute Arbitration and Mediation Law", the mediation agreement shall be signed or stamped by both parties. It shall take effect after being signed by the mediator and stamped with the seal of the mediation organization, and shall be effective for both parties. It is binding on the parties and must be performed.

6. After this agreement comes into effect, Party A and Party B will terminate the work-related injury insurance relationship, and Party B shall not initiate any legal proceedings regarding this work-related injury accident in the future.

7. This agreement is made in triplicate. Party A and Party B each hold one copy, and the labor department records one copy.

Party A (seal): _____ Party B (signature): _____

Representative signature: _____

_____ year _____ month _____ Part 4 of the Sample Work Injury Compensation Agreement

A: ____________________________

ID card: ____________________________

B: ____________________________

ID card: ____________________________

Party B was injured in an accident on _______ month _____, __________. After treatment and reexamination, he has now recovered. In order to properly resolve the matter of Party B's injury, Party A and Party B have reached the following agreement through friendly negotiation based on the principles of equality, voluntariness, mutual understanding and accommodation:

1. What actually happened from the date of Party B's injury to the date of signing of this agreement and other medical expenses and other expenses that should be paid by Party A, totaling ________ yuan (in capital letters: ____________ RMB), which have been paid in full by Party A before the signing of this agreement. Party B shall not make any further payments after the signing of this agreement. Claim against Party A for any expenses incurred during the aforementioned period for any reason.

2. Upon negotiation and agreement between Party A and Party B, Party A will pay a one-time subsidy totaling RMB _________ (in capital letters: ____________).

3. After Party B receives the one-time subsidy, it shall reasonably allocate and handle it, and consciously reserve enough for possible follow-up treatment, rehabilitation, living and other expenses. The way in which Party B allocates and handles the aforementioned expenses shall be decided by Party B at its own discretion, and Party B shall be solely responsible for the consequences.

4. After Party A and Party B sign this agreement, the labor relationship will be terminated. At the same time, Party B promises not to require any other fees or bear any responsibility from Party A for labor-related matters in any form or for any reason.

5. After Party B receives the one-time subsidy paid by Party A, if Party B makes any cost and responsibility requirements to Party A for any reason, Party B shall refund all fees paid by Party A to resolve this matter. , and shall bear all losses caused to Party A due to breach of contract, and shall pay Party A a liquidated damages of 20% of the one-time subsidy.

6. This agreement is the result of equal and voluntary negotiation between both parties. It is the true expression of both parties’ intentions and is fair and reasonable. This agreement is a one-time termination agreement. Both parties shall use this as a conclusion, fully and earnestly perform the contract, and shall not continue to argue for any reason. Any physical or mental problems that Party B may have in the future will have nothing to do with Party A.

7. Party A and Party B have read and understood the entire content of this agreement. Party A and Party B understand the consequences of violating this agreement. Party A and Party B are completely satisfied with the outcome of this agreement.

8. This agreement is made in two copies, with Party A and Party B each holding one copy. The agreement will become legally effective upon signature by Party A and Party B.

A:____________________

B:_________________________

____________year_______month_____day

____________year_______ Part 5 of the Sample Work Injury Compensation Agreement on _month_____

Party A (unit):

Legal representative:

Party B (worker): ____________ , female, ______ years old, address: _______________, ID number:

Party B had a fall accident in the employee dormitory of the company on the day of the year. After treatment and review, she has recovered. In order to properly resolve the matter of Party B's injury, Party A and Party B have reached the following agreement through friendly negotiation based on the principles of equality, voluntariness, mutual understanding and accommodation:

1. What actually happened from the date of Party B's injury to the date of signing of this agreement and other medical expenses, transportation expenses and other expenses that should be paid by Party A in *** Yuan (capitalized in RMB). Party B shall provide corresponding invoices and submit them to Party A before signing this Agreement, and Party A shall pay them in full Please note that after signing the agreement, Party B shall not claim against Party A for any expenses incurred during the aforementioned period for any reason.

2. Upon negotiation and agreement between Party A and Party B, Party A will pay Party B a one-time payment for disability benefits, one-time medical subsidy for termination of labor relationship, disability employment subsidy, and all other payments that should be paid by Party A according to law. Fees (hereinafter collectively referred to as "one-time subsidy"), totaling RMB (uppercase: ?).

3. Within days after signing this agreement, Party A will pay Party B RMB yuan (in capital letters: ? ), and the balance of RMB ? yuan (in capital letters: ) will be paid in full.

4. After receiving the one-time subsidy, Party B shall reasonably distribute and handle it, and consciously reserve enough for possible follow-up treatment, rehabilitation, living and other expenses. The way in which Party B allocates and handles the aforementioned expenses shall be decided by Party B at its own discretion, and Party B shall be solely responsible for the consequences.

5. After Party A and Party B sign this agreement, the labor relationship will be terminated. At the same time, Party B promises not to require any other fees or bear any responsibility from Party A for labor-related matters in any form or for any reason.

6. After Party B receives the one-time subsidy paid by Party A, if Party B makes any cost and responsibility requirements to Party A for any reason, Party B shall refund all fees paid by Party A to resolve this matter. , and shall bear all losses caused to Party A due to breach of contract, and shall pay Party A a liquidated damages of 20% of the one-time subsidy.

7. This agreement is the result of equal and voluntary negotiations between both parties. It is an expression of the true intentions of both parties and is fair and reasonable.

8. Party A and Party B have read and understood the entire content of this agreement. Party A and Party B understand the consequences of violating this agreement. Party A and Party B are completely satisfied with the outcome of this agreement.

9. This agreement is made in two copies, with each party A and B holding one copy. The agreement will become legally effective upon signature by both parties A and B.

10. This agreement is a one-time termination agreement. Both parties shall conclude this agreement, fully and effectively perform the contract, and shall not continue to argue for any reason. Any physical or mental problems that Party B may have in the future will have nothing to do with Party A.

Party A’s signature:

Time:

Attached: A copy of Party B’s ID card

Party B’s signature: Time: Work Injury Compensation Agreement Book Sample Part 6

Party A: ______

Party B: ______ (ID number: ______________)

Since ____ year ____ month ___ On ____, Party B was hired by Party A as a worker in the factory. On ____, ____, month ____, day ____, Party B was accidentally ______ injured while working. After the incident, Party A sent Party B to the hospital for treatment and paid all medical expenses. On ____ month ____ of ____, Party B went to the hospital again for follow-up medical surgery and has now recovered.

In order to resolve the work-related injury of Party B, Party A and Party B, based on the principles of equal negotiation, mutual understanding and mutual accommodation, and in accordance with the "Regulations on Work-related Injury Insurance", have reached an agreement through negotiation as follows:

1. Party A shall compensate Party B for one-time medical expenses, one-time medical and employment subsidies, work-related injury and disability subsidies, wages during work-related injuries, nursing expenses, food expenses, transportation expenses, economic compensation and other expenses *** calculated ________ Yuan (￥:______ yuan);

2. After Party B collects the above-mentioned fees, Party B voluntarily gives up the right to compensate for the difference;

3. After Party B collects the above-mentioned fees , the labor relationship between the parties will be terminated immediately;

4. Party B voluntarily waives all rights arising from the occurrence and termination of the labor relationship between the parties;

5. This agreement is made in duplicate. Hold one copy and it will take effect from the date of signature by both parties.

Party A: ____________ Party B: ____________

____year____month____day____year____month____day work injury compensation agreement template Chapter 7

Party A: __________ Party B: __________

In order to resolve the work-related injury of Party B, in accordance with the relevant provisions of the "Labor Dispute Mediation and Arbitration Law" and the "Work-related Injury Insurance Regulations", both parties shall act in accordance with the Based on the principles of equal consultation, mutual understanding and mutual accommodation, the following was reached after full consultation:

1. Party B was accidentally injured during the construction of the west platform tunnel of Chengchi Expressway on ____ month ____. All expenses incurred by Party B during the treatment process have been paid by Party A.

2. The labor relationship between the two parties will be terminated after the signing of this agreement.

3. Party A shall pay Party B a one-time compensation of _________ yuan. This paragraph includes Party B’s wages for suspension of work, transportation and accommodation expenses, nursing expenses, and hospitalization meal subsidies after the signing of this contract. Registration fees, hospitalization expenses, transportation and accommodation expenses, hospitalization meal subsidies, and nutrition expenses incurred during subsequent treatment , nursing fees, one-time disability employment subsidy, one-time work-related injury medical subsidy, disability allowance, life care fee, assistive device fee, one-time disability subsidy and related compensation arising from the termination of the labor relationship between the two parties, etc. item costs.

4. Party A will pay Party B one hundred thousand yuan in the above amount after the signing of this agreement; Party B will pay Party B ____ yuan before ____ month ____ in ____ year; Party A will pay the remaining amount to Party B The payment shall be completed before the end of 20____. If Party A encounters financial difficulties, Party A can postpone the payment until ____, month, ____, ____. If Party A fails to pay on time, Party A will pay 30% liquidated damages for the delay. To Party B.

5. After the signing of this agreement, the work-related injury compensation and the termination of the labor relationship have all been resolved, and neither party shall claim other rights against the other party.

6. This agreement is a voluntary and true expression of intention of both parties. It becomes effective upon signature of both parties. Neither party may repent for any reason.

Party A: __________ Party B: __________

Part 8 of the Sample Work Injury Compensation Agreement on ____month____, 20_____

Party A: < /p>

Gender: Date of birth: Year, month and day

Nationality: ID number: Home address:

Postal code: Contact number: Party B:

ID number:

Place of residence:

In view of the fact that Party A, in accordance with national laws and regulations and local regulations and other relevant provisions, Party A and Party B have The regulations and whether it is a work-related injury and its treatment results are clearly understood. In order to resolve the one-time compensation issue for Party A's work-related injury, both parties have reached the following agreement through voluntary and equal consultation based on the principles of fairness and reasonableness, mutual understanding, honesty and trustworthiness, and in accordance with relevant laws and regulations:

1. Amount of compensation

1. Party A and Party B unanimously confirm that Party B’s monthly treatment fee will be calculated in RMB, (in capital letters: ).

2. On the basis of confirming the amount of medical expenses in Article 1, Item 1 of this Agreement, Party A and Party B agree to calculate the compensation according to Chongqing’s standard terms of work-related injury compensation as follows:

A. 6-month suspension period,

B. 8-month one-time disability benefit,

C. 4-month one-time medical benefit,

D. One-time employment subsidy for 9 months,

***27 months as the base, the average social wage last year was 3783 yuan/month, ***3783*27= 102141

Yuan. Other expenses include 2,839 yuan, totaling 105,000 yuan.

3. When paying, deduct related previous borrowings, the amount is: 7086 yuan

4. The amount payable is: 97914 yuan. (Note: The actual payment was 98,000 yuan).

II. Payment Period

Within five working hours from the date of signing this agreement, Party B can pay the above amount by cash or bank transfer. The payment method is: cash payment

3. Party A and Party B agree that from the date of signing this agreement, the labor relationship between the two parties will be terminated.

IV. From the date of signing this agreement, Party A voluntarily gives up its right to compensation.

5. Party A voluntarily gives up all rights arising from the occurrence and termination of the labor relationship between the two parties.

6. After the signing of this agreement, Party A and Party B terminate all rights and obligations related to compensation for work-related accidents. Party A shall not claim any additional rights against Party B, and Party B will no longer assume any obligations. Both parties will no longer have any rights and obligations. any disputes, and one party waives all legal liability against the other party. At the same time, from the date of signing this agreement, Party A voluntarily waives all arbitration, litigation and other rights regarding the termination of the labor relationship and work-related injury compensation between the two parties.

VII. Liability for breach of contract

1. If Party B delays payment, Party A has the right to require Party B to pay the balance in one lump sum, and has the right to require Party B to pay interest according to the interest rate of the People's Bank of China for the same period of payment. .

2. If any party’s breach of contract leads to arbitration, litigation or application for compulsory execution, the other party shall pay the costs of realizing the creditor’s rights, including but not limited to investigation and evidence collection fees, transportation fees, tolls, lost work fees, Notary fees, attorney fees, and other economic losses.

8. Party A and Party B voluntarily abide by and perform the above terms.

9. This agreement will take effect from the date it is signed and sealed by Party A and Party B. This agreement is made in two copies, with Party A and Party B each holding one copy.

Party A: Party B:

Year Month Day Year Month Day Work Injury Compensation Agreement Template Part 9

Party A:

Party B :

Party B went to work for Party A around March. During the work in April, due to careless operation, his left hand was injured. Party A fully considered that Party B’s work was not easy and was indeed injured. Party B fully respected Party A. After full negotiation, the two parties reached the following compensation agreement for both parties to abide by:

1. Party B’s medical expenses based on this injury shall be borne entirely by Party A, that is, Party B shall not be allowed to bear any compensation based on this injury. Medical treatment will pay any medical expenses, but Party B also promises that it will not occupy any medical expenses based on this medical treatment.

2. Based on full negotiation, Party A will pay Party B’s lost wages, nursing fees, business expenses, wages during the suspension of work, one-time disability subsidies, mental loss fees, one-time medical subsidies, The total amount of one-time employment subsidy, disability compensation and other items is RMB. Payment shall be made within 2 days after Party A and Party B sign this agreement.

3. After the signing of this agreement, all rights and obligations between Party A and Party B will be terminated. Both parties A and B promise that signing this agreement is an expression of their true intentions and they understand the legal consequences of signing this agreement. If Party A goes back on its word, in addition to paying the above fees, it shall compensate Party B 50,000 yuan. In addition to continuing to be binding, Party B shall also compensate Party A for 50,000 yuan. If any dispute arises due to this agreement, it shall be arbitrated by Ziyang Arbitration Commission. This agreement is effective upon signature in two copies, with each party holding one copy.

Party A’s signature and seal: Party B’s signature:

Year, month and day work injury compensation agreement template, Part 10

Party A (unit):

Party B (individual):

ID number:

In order to resolve the work-related injury of Party B, both parties have reached the following agreement through voluntary and equal consultation and in accordance with the provisions of relevant laws and regulations. Content:

1. Work-related injury history

Party B was injured while working for Party A on the year, month and day.

Main injuries:

2. Compensation amount and payment

1. Both parties confirm that before signing this agreement, Party A has paid or assumed the following obligations to Party B: Expenses: The total of medical expenses and other items is RMB (in capital letters) (￥ yuan).

2. In addition to what has already been paid, Party A agrees to pay Party B work-related injury compensation: RMB (in capital letters) (￥ yuan).

The above-mentioned work-related injury compensation includes but is not limited to medical expenses, nursing expenses, follow-up treatment expenses, disability assistive device expenses, disability subsidies, disability benefits, employment subsidies, and medical subsidies caused by work-related injuries. , dependent relatives, wages and benefits during the layoff period, and all compensation, expenses and benefits related to work-related injuries, as well as economic compensation and other benefits for the termination of the labor relationship.

3. Work injury compensation payment time: paid before the year, month and day.

4. Handling of work-related injury insurance: All parties agree to handle it in the following manner:

(1) Party A cooperates with Party B to declare work-related injury insurance and other social insurance benefits. Compensation from social insurance (including work-related injury insurance) is included in the work-related injury compensation amount stipulated in this agreement. If Party A has fully paid work-related injury compensation to Party B, the work-related injury benefits paid by the work-related injury insurance fund and social security fund shall belong to Party A (if it has been paid to Party B, Party B shall return it to Party A accordingly).

(2) Party A cooperates with Party B to apply for work-related injury insurance and other social insurance benefits. The compensation paid by the work-related injury insurance fund is not included in the work-related injury compensation amount stipulated in this agreement. Party A shall pay separate work-related injury compensation in accordance with this contract in addition to the amount paid by the work-related injury insurance fund.

5. Party B

Designated payment account number:

Account opening bank:

Account name:

Three , Termination of the labor relationship

1. Both parties agree that the labor relationship between the two parties will be terminated on the year, month, and day (the date of termination); the compensation for the termination of the labor relationship has been calculated into the work-related injury compensation stipulated in this agreement.

2. Party A shall pay wages normally until the termination date. The wage standard is: RMB per month.

4. Special Statement

After the signing of this agreement, all rights and obligations of Party A and Party B regarding work-related injuries and performance/termination of labor relations will be settled. All items in work-related injury benefits (including (but not limited to subsequent medical expenses, etc.) have been included in the agreed work-related injury compensation. Party B shall not separately claim any rights, labor remuneration, compensation, damages, or expense reimbursement from Party A, and shall not initiate supervision, labor arbitration, or litigation.

Party B confirms that it understands the condition of its injury. Any changes in the condition of the injury will not affect the execution of this agreement.

If Party B has not conducted a labor ability appraisal before signing this agreement, Party B agrees to give up the labor ability appraisal, and the effectiveness and performance of this agreement will not be affected by the results of the labor ability appraisal in the future.

5. Liability for breach of contract

If any party's breach of contract leads to arbitration, litigation or application for compulsory execution, the other party shall pay the costs of realizing the creditor's rights, including but not limited to investigation and evidence collection fees, Transportation costs, tolls, lost work costs, notary fees, attorney fees, and other economic losses.

VI. Others

1. This agreement is made in two copies. Party A and Party B each hold one copy, which has the same legal effect.

2. This agreement will take effect from the date of signature by Party A and Party B.

Date of signature: year, month and day

Party A:

Party B:

Signature of Party B’s relative:

Witness signature: Work Injury Compensation Agreement Template Part 11

Party A:

Address:

Legal representative (operator):

Employer:

Party B: ID number:

When Party B was assigned to engage in sales work at XXXX Co., Ltd. at around 10:57 on XXX, month XXX, XXX, The vehicle he was riding in was involved in a car accident on the G65 heading out of the city, resulting in injuries to his left hand, head and nose. He was treated at the Nanchuan District People's Hospital of Chongqing.

On March 21, XXXX, he was appraised by the Labor Ability Appraisal Committee of Dadukou District, Chongqing (for the first time). The appraisal conclusion was: ninth-level disability, no impairment in self-care.

Based on the principles of equality, voluntariness and consensus through consultation, Party A and Party B reached the following compensation agreement:

1. The payment part of the xx City Work Injury Insurance Fund is as follows:

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(1) One-time disability subsidy: 9*3370=30330.00 yuan

(2) One-time work-related injury medical subsidy: 4*5616=22464 yuan

(3) Food subsidy during hospitalization: 7*8=56 yuan

(4) Disability appraisal fee: 400 yuan

2. The actual portion paid by the employer is as follows:

(1) One-time disability employment subsidy: 9*5616=50544 yuan

(2) Wages during the suspension period: 3*3500=10500 yuan

(3) Medical transportation expenses: 350 yuan

(4) Living allowance: 3,600 yuan

The above benefits will be paid by the Chongqing Work Injury Insurance Fund 3 days after the fund is settled. A one-time payment of XXX yuan shall be made to Party B within three working days. The XXX yuan that shall be paid by Party B shall be paid by Party A to Party B in a lump sum on the date of signing the agreement. Party B shall issue a receipt certificate to Party A. The details shall be subject to the receipt certificate.

3. Both Party A and Party B agree that the labor relationship between Party B and Party A will be terminated on XXXX, XXXX.

4. Party B voluntarily waives all rights arising from the labor relationship and termination of the labor relationship between the parties (including procedural rights: arbitration and litigation).

5. After both parties sign this agreement, and after Party B actually receives the compensation corresponding to this agreement, Party B agrees to waive any civil claims against Party A and other relevant parties in the form of arbitration or litigation for any reason and in any way. The right to compensation or other supplementary compensation, Party B promises not to hold Party A and the corresponding personnel of relevant parties responsible for any legal liability.

6. This agreement is made after both Party A and Party B are very familiar with the Labor Law, Labor Contract Law, Work Injury Insurance Regulations, Social Insurance Law and other relevant laws and regulations. Signed on this basis, the content of this agreement has been read and understood in full by Party A and Party B. It is the true intention of both parties and both parties are willing to abide by it consciously.

7. This agreement is made in triplicate, with Party A and Party B each holding one copy and the mediation agency holding one copy. It shall take effect from the date of signature and seal of the three parties.

Party A’s signature: (seal) Party B (signature and seal):

Party A’s representative:

Year, month, day, year, month, day