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OPD-Dec 2024

The document is a reimbursement claim form submitted by Mr. M Adil Maneka for medical expenses totaling Rs. 27,391, covering various consultations and medicines for himself, his wife, and son. The claim includes detailed entries with dates and amounts for each type of reimbursement. It also contains a declaration statement and sections for signatures from relevant departments for verification and approval.

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Muhammad Adil Maneka
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9 views1 page

OPD-Dec 2024

The document is a reimbursement claim form submitted by Mr. M Adil Maneka for medical expenses totaling Rs. 27,391, covering various consultations and medicines for himself, his wife, and son. The claim includes detailed entries with dates and amounts for each type of reimbursement. It also contains a declaration statement and sections for signatures from relevant departments for verification and approval.

Uploaded by

Muhammad Adil Maneka
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Quaid-e-Azam Thermal Power (Pvt.

) Limited
( OPD Reimbursement Claim Form )
Employee Name : Mr. M Adil Maneka Designation Assistant Manager Contracts
Claim Date : 31/12/24
Sr # Rec # Reimbursement Type Relation Relative Name Bill Date Total Amount

1 231428 Medicines Self Muhammad Adil Maneka 30/12/24 2,421


2 271220246640Consultation Self Muhammad Adil Maneka 27/12/24 2,500
3 746 Consultation Self Muhammad Adil Maneka 30/12/24 3,500
4 186706 Medicines Wife Sana Altaf 23/12/24 301
5 19058 Consultation Son Muhammad Zaviyar 23/12/24 8,000
6 675 Consultation Wife Sana Altaf 23/12/24 4,000
7 001240766772Tests Wife Sana Altaf 22/12/24 3,160
8 1696148 Medicines Son Muhammad Zaviyar 16/12/24 78
9 1688705 Medicines Wife Sana Altaf 11/12/24 350
10 1591245 Medicines Self Muhammad Adil Maneka 27/12/24 3,081
Total (Rs.) : 27,391

Declaration
I hereby declare that all information provided and submitted documents with claim form are true and original.

Signature of the Employee Date Recommended By HOD Date

Verified By HR Department Date Approved By GM Admin&HR Date

Paid By Finance Department Date

Recievd By Date

List to be Attached:
* Original Bills Reciepets with date.
* Medical Tests Invoices (Copy) with date & name of patient.

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