RECONCILIATION AGREEMENT

This Reconciliation Agreement is entered into on 13/12/2015 (the “Effective Date") by and between:

1. Provider Name: __________________________________________ Provider ID: ___________, a facility

incorporated under the laws of the Emirate and the federal laws of the UAE its principle address
____________________________________P O Box ____________.
2. WAPMED TPA Services, a company incorporated pursuant to the laws of Emirate and the federal laws of
the UAE P.O. Box 505138 & Head Office at Al Jaber Street Kuwait, (hereinafter referred to as “TPA”); and

Provider and TPA shall hereinafter be individually referred to as the “Party” and jointly as the “Parties”.

WHEREAS;

A. On behalf of Payer the TPA has already made all payments due to the Provider for all the covered
healthcare services rendered by the Provider to the insured members from 01/01/2013 till 31/12/2013.

B. The Parties have agreed to conduct a reconciliation covering the period from 01/01/2013 till 31/12/2013
hereinafter referred to as the “Term”).

Now, therefore, in consideration of the foregoing, the Parties agree as follows:

1- The Provider hereby acknowledges receiving, in full, all payments, dues and charges payable by TPA on
behalf of the payer during the Term. No further claims for payment of any dues related to the healthcare
services rendered during the Term may be claimed by the Provider at any future time.
2- E a c h Party hereby discharge the other from all obligations and liabilities and, further, irrevocably waives
any and all demands, dues, claims, whether existing or future, whatsoever arising from or in connection
with the healthcare services rendered throughout the Term.
3- This Reconciliation Agreement will be deemed as an evidence of final clearance and settlement of all
amounts and claims due to the Provider in relation to the healthcare services rendered during the Term by the
Provider to the insured members.

4- Both Parties agreed that the Payer/TPA shall not conduct any audit on the Provider's medical and billing
records related to the healthcare services rendered during the Term after signing this agreement;
5- Claims pertaining for the period From 01/01/2013 till 31/12/2013:
6- Both Parties mutually agreed on 25/11/ 2015 to close financial liabilities pertaining to specified TERM

In witness whereof, the Parties have executed this Reconciliation Agreement on the date set hereinabove.

For and on behalf For and on behalf of TPA

of Provider :

Name: Name:
Title: Title:
Stamp & Signature Stamp & Signature
 RECONCILIATION AGREEMENT

This Reconciliation Agreement is entered into on 13/12/2015 (the “Effective Date") by and between:

1. Provider Name: __________________________________________ Provider ID: ___________, a facility

incorporated under the laws of the Emirate and the federal laws of the UAE its principle address
____________________________________P O Box ____________.
2. WAPMED TPA Services, a company incorporated pursuant to the laws of Emirate and the federal laws of the
UAE P.O. Box 505138 & Head Office at Al Jaber Street Kuwait, (hereinafter referred to as “TPA”); and

Provider and TPA shall hereinafter be individually referred to as the “Party” and jointly as the “Parties”.

WHEREAS;

A. On behalf of Payer the TPA has already made all payments due to the Provider for all the covered
healthcare services rendered by the Provider to the insured members from 01/01/2014 till 31/12/2014.

B. The Parties have agreed to conduct a reconciliation covering the period from 01/01/2014 till 31/12/2014
hereinafter referred to as the “Term”).

Now, therefore, in consideration of the foregoing, the Parties agree as follows:

1. The Provider hereby acknowledges receiving, in full, all payments, dues and charges payable by TPA on
behalf of the payer during the Term. No further claims for payment of any dues related to the healthcare
services rendered during the Term may be claimed by the Provider at any future time.

2. E a c h Party hereby discharge the other from all obligations and liabilities and, further, irrevocably waives
any and all demands, dues, claims, whether existing or future, whatsoever arising from or in connection
with the healthcare services rendered throughout the Term.

3. This Reconciliation Agreement will be deemed as an evidence of final clearance and settlement of all
amounts and claims due to the Provider in relation to the healthcare services rendered during the Term by the
Provider to the insured members.

4. Both Parties agreed that the Payer/TPA shall not conduct any audit on the Provider's medical and billing
records related to the healthcare services rendered during the Term after signing this agreement;

5. Claims pertaining for the period From 01/01/2014 till 31/12/2014:

6. Both Parties mutually agreed on 13/12/2015 to close financial liabilities pertaining to specified TERM

In witness whereof, the Parties have executed this Reconciliation Agreement on the date set hereinabove.

For and on behalf For and on behalf of TPA

of Provider :

Name: Name:
Title: Title:
Stamp & Signature Stamp & Signature