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= Acknowledgment =

Employee Health Insurance

This is acknowledged that Branch/Location is sending you Re-


Imbursement claim of Mr./Ms. Designation
under Askari Insurance Company , amounting Rs. _only
on dated . We confirm that He/She belongs to said Branch/Location
and our Client/Employee.

Sent By: Verified By Supervisor:

Name: Name:
Date: Date:
For HO Use Only

= Receipt =
This is confirmed that we have received said client/Employee’s claim on dated
and will sent to concern Insurance Company for settlement.
Received By: Endorsed By:

_________________________________________ __________________________________

Sign & Date (HR Department) Managing Director


= Settlement =
This is update that said claim is settled on from concern Insurance
Company amounting Rs. as per your individual policy plan limit and
SSF Health Insurance Policy.

= Receiving by Client/Employee =
I, Client/Employee of Branch/ Location
of SAFCO Microfinance Company received an amount of Rs. /- in words
only/- on dated though cheque/cash.
Received By: Given By: Verified By:

Sign:

Name:

CNIC:

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