1, write down my name, gender and ID number first.
2, the specific time of the accident, resulting in finger bone injury, the specific time in which hospital.
3. Explain that I guarantee that the above situation is true, and I guarantee that this trauma has nothing to do with the third party, and no third party has paid the medical expenses. If it is untrue, I am willing to return the overall payment fund and bear the corresponding legal responsibilities.
The promisor signs and writes the date of signature.