TABLE OF CONTENTS

A. Endorsement Letter from Unit Commander (PAMUs).

B. Accomplished Voucher with Signatures from Unit Assignment.

C. Original Copy of Statement of Accounts or Hospital Bills.

D. Tabulated Summary of Receipts According to Date and Original

Copy of Official Receipts within Confinement Period.

E. Original Copy of Medical Certificate from Hospital to include

Procedures & Treatment Done by Attending Physician and Original
Copy of Clinical Abstract.

F. Original Copy of Certificate from CO, MTF within the Nearest

Location of Hospitalization Based from the Clinical Abstract and
indicate if the Case is Emergency in Nature or Not Emergency in
Nature and if the Hospital has no Capability to Handle the Case.

G. Original Copy of Certification from Ward/Supply/Logistics Officer

the Unavailability of Services/Supplies (if confined at MTF) and
Referral Letter.

H. Copy of Spot/Incident and Police Report for Traumatic Incident to

include State of Influence of Liquor/Alcohol (if applicable) and
Copy of LOD Board/Report.

I. Proofs such as Back to Back Copy of Mil ID, Dep ID, NSO Copy of
BC, DC, MC to support the Claim for Patient.

J. Certificate of Active and Bonafide Member of the AFP.

K. Back to Back Copy of Landbank ATM Card and Contact Nr.