Medical Reimbursement Claim for Outdoor Treatment
2
Medical Reimbursement Claim for Outdoor treatment for the month of November’13 of Sri Ashutosh Sarker, Sr. OA !"# retired on 3$%11%$& !A%N# 'ia(nostics% ests) Sl. No. *oucher No. 'ate Amount 1 R+ -1 $/%11%13 13$.$$ R+ &11-3 11%11%13 $$.$$ 3 R+ &-0-/ 1&%11%13 0$.$$ R+ &-0-- 1&%11%13 11$$.$$ 0 R+3$ 1- 1&%11%13 $$$.$$ 2O%13% $31/ %11%13 $.$$ / $/ O2 13 1 1 %11%13 $$.$$ otal 1$,0$$.$$ Medicines% 4n5ections) Sl. No. *oucher No. 'ate Amount - - & %11%13 1$$.$$ & CA 0 3- -%11%13 1//.0$ otal //.0$ "rand otal 1$,///.0$ !Rs. en housand Seven +undred and Sevent6 Seven and 7ift6 8aisa onl6 # !Si(nature of the 9m:lo6ee# Ashutosh Sarker, 9;. Sr. OA !"# Retired on 3$%11%$& !A%N# <al6ani Cash Collection O%o the Area Mana(er !2<8# Mob. No. $& 33$$- -&
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Transcript of Medical Reimbursement Claim for Outdoor Treatment
Medical Reimbursement Claim for Outdoor treatment for the month of November13 of Sri Ashutosh Sarker, Sr. TOA (G) retired on 30/11/09 (A/N)
Diagnostics/ Tests:
Sl. No.
Voucher No.
Date
Amount
1
RH281226
07/11/13
130.00
2
RH291183
11/11/13
600.00
3
RH298587
19/11/13
250.00
4
RH298588
19/11/13
1100.00
5
RH302186
19/11/13
6000.00
6
BO/13/403174
22/11/13
220.00
7
07-OB-13-12621
22/11/13
2200.00
Total
10,500.00
Medicines/ Injections:
Sl. No.
Voucher No.
Date
Amount
8
826492
26/11/13
100.00
9
CA-5438
28/11/13
177.50
Total
277.50
Grand Total 10,777.50
(Rs. Ten Thousand Seven Hundred and Seventy Seven and Fifty Paisa only )
(Signature of the Employee)
Ashutosh Sarker, Ex. Sr. TOA (G)Retired on 30/11/09 (A/N)
Kalyani Cash Collection
O/o the Area Manager (BKP)
Mob. No. 09433008489
