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Medical Reimbursement Claim For Outdoor Treatment

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VikasSaini

Vikas Saini, a JE in the EB/Mktg department located in Sector 18, Gurgaon, has submitted a medical reimbursement claim totaling Rs. 10,381 for outdoor treatment. The claim includes 6 bills from September 11th to November 21st for amounts between Rs. 533 to Rs. 3,800. Vikas declares that the information provided is accurate and that the expenses were incurred for a wholly dependent person.

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Medical Reimbursement Claim For Outdoor Treatment

Uploaded by

VikasSaini
31 views1 page
Vikas Saini, a JE in the EB/Mktg department located in Sector 18, Gurgaon, has submitted a medical reimbursement claim totaling Rs. 10,381 for outdoor treatment. The claim includes 6 bills from September 11th to November 21st for amounts between Rs. 533 to Rs. 3,800. Vikas declares that the information provided is accurate and that the expenses were incurred for a wholly dependent person.

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Medical Bill

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Vikas Saini, a JE in the EB/Mktg department located in Sector 18, Gurgaon, has submitted a medical reimbursement claim totaling Rs. 10,381 for outdoor treatment. The claim includes 6 bills from September 11th to November 21st for amounts between Rs. 533 to Rs. 3,800. Vikas declares that the information provided is accurate and that the expenses were incurred for a wholly dependent person.

Copyright:

© All Rights Reserved
Download as DOCX, PDF, TXT or read online from Scribd
Download as docx, pdf, or txt
31 views1 page

Medical Reimbursement Claim For Outdoor Treatment

Uploaded by

VikasSaini
Vikas Saini, a JE in the EB/Mktg department located in Sector 18, Gurgaon, has submitted a medical reimbursement claim totaling Rs. 10,381 for outdoor treatment. The claim includes 6 bills from September 11th to November 21st for amounts between Rs. 533 to Rs. 3,800. Vikas declares that the information provided is accurate and that the expenses were incurred for a wholly dependent person.

Copyright:

© All Rights Reserved
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MEDICAL REIMBURSEMENT CLAIM FOR OUTDOOR TREATMENT

NAME OF EMPLOYEE : Vikas Saini (Mob 9958135619)

HR NO : 200904740

DESIGNATION : JE (EB/Mktg)

PLACE OF DUTY : Sector 18, Gurgaon

BILLS CLAIMED : (as follows)

CLAIM NO AMOUNT
00000000000001910911 1846
00000000000001910970 533
00000000000001911021 3800
00000000000001911283 544
00000000000001911363 793
00000000000001911628 2865
TOTAL AMOUNT 10,381 /-

Declaration : I hereby declare that the statements given in the application are true to the
best of my knowledge and belief and that the person for which medical expenses are
incurred is wholly dependent on me.

(Vikas Saini, JE)

(Mob 9958135619)

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