Application Letter Formats For Reimbursement of Medical Bills

The Administrative Officer,

Delhi Jal Board

Aurobindo Marg

New Delhi – 110030

Subject – Application for Reimbursement of Medical Bill

Respected sir,

I, Mr. Pankaj Sharma, am working as Assistant Engineer in the DJB department. My father, Mr. Chand Sharma, is suffering from COPD hypertension. He is taking treatment at the All India Medical Institute, Delhi. My father had been advised to do an ECHO test by Dr. Anand Ahuja. So I incurred Rs. 2000/- on it. I am submitting the required documents & original bill along with my application.

Please consider my application for reimbursement of my bill. I shall be thankful to you.

Thank You

Yours faithfully

Pankaj(your signature)

Mr. Pankaj Sharma

Dated – 04-12-2021

List of enclosures:-

Medical Reimbursement Form

Copy of Medical Book/ CGHC Card

Original Referral Form

Original Medical Bill

Format:- 2

The Director/Concerned Officer

Immortal Technology

Gurgaon

Subject – Reimbursement of Medical bills

Respected sir,

I, Mrs. Neelam Chaudhary, have been working in the Human Resources department. I underwent surgery at Bara Hindu Rao hospital on 16-12-21.

During the surgery, some medicine & articles were required. I am enclosing the bills, certificate B, and discharge slip along with my application. Kindly reimburse my medical bills as per the rules.

With Regards

Neelam Chaudhary

Manager

HR Department

List of enclosures:-

Medical Reimbursement Form

Copy of Medical Book/ CGHC Card

Original Referral Form

Original Medical Bill

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