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    Medical Reimbursement

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    vinay_electrical

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    Medical Reimbursement

    Uploaded by

    vinay_electrical
    6 views1 page

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    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLSX, PDF, TXT or read online from Scribd
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    Download as xlsx, pdf, or txt
    6 views1 page

    Medical Reimbursement

    Uploaded by

    vinay_electrical

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 1

    Name of the Employee Place of Posting

    E.No. DOJ
    Designation
    Department
    Reimbursement of Medical bills for the period_____________________
    Pertains to
    Name of the Medical Amount
    Rs. (mention self /
    S.No. Bill No. Bill Date Shop / Doctor / Hospital / Remarks
    family member
    Diagnostics
    name)

    Total Rs.

    Note : Please attach prescriptions along with the bills.

    Signature of the Employee Signature of HR


    Date:

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