Date:

Name:
Position:
Company:
Address:

Dear Mr./Ms. _______:

The undersigned is hereby requesting for reimbursement of medical expenses

incurred due to SARS-Cov-2 . Philhealth benefits for SARS-CoV-2 testing was
not availed of or was not deducted from the actual charges due to the urgency
of the matter and out of fear that my family may be exposed to Covid-19 thru
me.

Your favorable action regarding this matter is earnestly desired.

Yours,
________.