OIL & NATURAL GAS CORPORATION LIMITED

MEDICAL REIMBURSEMENT BILL

CPF NO : 00081368 Name JADAV CHANDRA BORA Submission No:S000090695

Designation:Ex.Engr.(Electn) Sec/Org Unit: Location:
Treatment Type :OUTDOOR

Sl Name of the Patient Age Relatio Nature of Illness Name of Amount Claimed For Office Use Only
No nship Doctor/Specialist

1 PRONITA BORA Spouse Chemotheraphy , Chemotheraphy , RAMESH SAHARIA , 3,250.00

57 SIBSAGAR TO

Amount Claimed ( in words) Rupees THREE THOUSAND TWO HUNDRED FIFTY ONLY 3,250.00

Certified that - (a) the claim is as per actual expenditure incurred. Passed for Payment of Rs.
(b) the person for whom expenses have been incurred is dependent on me

Date:10.09.2021 Signature of Employee (Rupees_________________)

Sanctioned subject to admissibility, verification Claim verified and recommended
by M.O or Medical section and pre-audit. for Payment of Rs

Sign. & Seal of

Date:10.09.2021 Sign of Conrtolling Officer Date: Sign I/C Medical Section Finance Ofiicer

Details of enclosed Cash Memos / Receipts

Patient Name Cash Memo Bill Date Bill Amount Subtotal for each
Individual
PRONITA BORA 18910 07.09.2021 250.00

TA FARE TO AND FRO 07.09.2021 3,000.00