Date: _ _ /_ _/ _ _ _ _

Provider’s Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Dear,

We kindly request you to provide us the following in order to reconcile our accounts:

 Statement of Accounts: Month wise and Payer wise (As per attached Format)

 Period: From _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ To _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Others/Remarks: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Your cooperation in this regard will be highly appreciated.

With Regards

Finance Department.

Received By: _ _ _ _ _ _ _ _ _ _ _ Received Date: _ _ _ _ _ _ _ _ _ _ _