Notice of application

Leaders:

I am XXX, gender X, and now I live in XXXXXXXXXXXX. Because I was hospitalized with XX disease, I spent a lot of expensive medical expenses of XXXXXXXX yuan. My family income is low, and the per capita income is only XX yuan. I used to be poor, but now I owe a lot of debts because of illness, and my life is in trouble. I am here to apply for medical assistance from the government to help me tide over the difficulties.

Please ask the leader for approval!

Applicant: XXX

XXXX year x month x day

If it is a company, you can also apply this format and change the "government" to the company name. This is a common format, please adopt it.