CERTIFICATE

1. It is certified that all the Original Medical Bills above Verified and Found

Correct.

2. If any fraud Bills Color Xerox Bills and Duplicate Bills Claimed amount

The I am the held fully responsibility of Medical Reimbursement.

3. I have uploaded all Medical Original Bills in Original 12 No’s of documents

4. All the Original Medical Bills kept in ICS Custody.

DDO Phone No. : DDO Signature

 GOVERNMENT OF ANDHRA PRADESH

EDUCATION DEPARTMENT

From : To :
SRI K. CHALAPATHI, M.Sc., B.Ed. The Commissioner,
Gazetted Head Master, Director of School Education,
ZPP High School, Gangapatnam, Ibrahimpatnam, Vijayawada,
Indukurpet Mandal, SPSR Nellore Dist. Andhra Pradesh.

Lr. No………………………………………………Dated -04-2019

Sir,
Sub. : Submission of MR Bills of Mr. W. Vivek, S/o. K. Leelamma, SA (Eng.),
ZPP High School, Gangapatnam, Indukurpet Mandal, SPSR Nellore
Dist. Request for Scrutiny and Sanctioning of Admissible Amount
Rs. 60,386-92 - Reg.

The detail of Medical Reimbursement Bills submitted to you for

Scrutiny and Sanctioning of Admissible Amount as per the Existing
GO’s are as follows :
Name of the Patient/Beneficiary : Mr. W. VIVEK

Name of the Employee/Pensioner : Smt. K. Leelamma

Relation with Beneficiary : Son

Claim submitted by : Smt. K. Leelamma, SA (Eng.)

Name of the Hospital : Krishna Institute of Medical Sciences Ltd.,

Dargamitta, Nellore
Whether the approved by DME or Not : YES

Date of Admission : 04-03-2019

Date of Discharge : 06-03-2019

Amount Claimed : Rs. 60,386-92

I certify that the Original Bills are kept in my safe custody and physically verified and
found the following documents submitted by the employee/pensioner.
 Appendix – II
 Non-Drawal Certificate
 Emergency Certificate
 Essentiality Certificate
 IP / OP Bills
 Original Discharge Summery
 Copy of DME Approved Proceedings
Any other relevant documents :