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["    开平市工伤保险长期待遇生存认证代办人承诺书"]
["生存认证人姓名",null,null,"生存认证人身份证号"]
["代办人姓名",null,null,"代办人身份证号"]
["与认证人员关系",null,null,"代办人联系电话"]
["代办人联系地"]
["   现因需工伤保险长期待遇生存认证人员"]
["   □年老体弱、行动不便"]
["   □在国（境）外"]
["   暂无法提供生存状况证明材料。本人受其委托前来代办工伤保险生存认证，且已扫描”开平市工伤保险长期待遇生存认证“二维码，并上传生存人员有关信息和材料，现本人做出如下承诺："]
["   代办人受生存认证申请人的委托，代办工伤保险长期待遇生存认证。认证人已扫“开平市工伤保险长期待遇生存认证”二维码，并按要求上传资料，在此郑重承诺，填报和提交的所有信息均真实、准确、完整、有效，并授权同意经办机构可通过有关部门查询本人与承诺相关的个人信息，用于核实承诺内容的真实性。同时知悉，代办人如提供虚假情况及资料，愿协助追回多发放的待遇，以及涉及其他方面的全部法律责任。"]
[]
[]
[]
[]
[" "]
[{"$nulls":4},"代办人签名："]
[{"$nulls":4},"   年    月    日"]

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