Habib Insurance Company Limited

Medical Reimbursement Form

Date: 2l-02-2024

l he Assistant Ceneral Manager

Ilabib Insurance Companl, Limited

I(arachi

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Sir.

The llills relate to my sickness/ sickness of family Name Irfan Haider & Family

'I'he
naturc olsickness is described lrereunder:-

I. Consultation Fee Rs. 1,200.00

2. Vaccination Rs.

3. X-Itay, E C G. Blood lest e*. Rs.

.1. Cost of Medicines etc. Rs. 8562
5. Other not included above Rs.

Total

Employee Name : Irfan Haider

Ernployee Desg Assistant Manaqer (Admin)

Employee Branch : Faisalabad

Eulployment No

I hereby confirm that the tnformatr - r given is correct to the best ofmy knowledge.

For H.R & Admin Depart U

Medical Entitlement

Medical Availed

Medical Balance

lntbrnration Enter By : Check By :

rrarks t Approved: l*,

tcr Aller Approval Approved By :

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trl.R. No. rMR32024l 18490 pru"ntiell +r oioozosoizo
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,irfan Haider Age/Gender: 42 YEAR
I MALE
Token Number
Il.lstitutuion/Panel: N/A 76
l-iicntion: MO ROOM
Created By: RCP ZAHRA ISMAIL

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