Attached Form

Attached Form 1 in relation to traffic accidents listed in paragraph (2).

A. The Plaintiff is an insurer who entered into a comprehensive automobile insurance contract in attached Form 1 with respect to vehicles C and D with the insurance period from November 11, 201 to November 11, 2012.

B. On January 19, 2012, around 16:00, a traffic accident in attached Form 2 (hereinafter “instant accident”) was occurred, where the Defendant’s driver’s vehicle D at the intersection near Daejeon-gu Incheon Metropolitan Government apartment complex, where the signal cross-section of the Defendant’s driver’s vehicle in the direction of the signal.

C. On January 25, 2012, the Defendant was diagnosed as base salt and tensions, the salt and tensions of the Yacheon, the detailed brain-proofs of an unidentified, the salt and tensions of the shoulder, and the salt fruits and tensions of the chest of the shoulder, and was hospitalized from January 25, 2012 to February 21, 2012. < Amended by Act No. 11334, Jan. 25, 2012>

The defendant was exposed to the J Hospital while being hospitalized in the above G GH and was exposed to the MI photographs of the Meetical and Meetical conditions.

As a result of the examination, the vertecopic flife, accompanied by the escape from a conical signboard between the right-side 4-5 and the light 5-6, is observed, and the vertecopic flifecule is hospitalized in J Hospital from February 22, 2012 to March 2, 2012, and the same month.

5. The same month after receiving the procedure for the operation of the rasher for the anti-scopic and anti-scopic diameter.

8. The discharge was made.

The plaintiff in the same month.

7. From the person in charge of the same hospital, he/she was diagnosed by the medical officer in charge of the same hospital that he/she needs to undergo preservation medical treatment and subsequent re-evaluation for 4 weeks with the name of the disease, such as the flat, flat, flat, spine, blat, vertebral, verte, vertebral, vertebral, vertebral, vertebral, vertebral, etc. accompanied by the nephal ppuri disease (hereinafter “the instant injury”).

E. From January 25, 2012 to February 29, 2016, the Plaintiff paid KRW 25,035,130 to each medical institution as the Defendant’s medical expenses.

[Ground of recognition] Facts without dispute, Gap evidence 6, 10, 13, Eul evidence 7 and 9, the purport of the whole pleadings

2. Plaintiff’s assertion and judgment

A. The plaintiff's assertion is the defendant of this case.