Claim Submission Summary Listing

Employee ID: 64132590

Employee Name: Herawaty Binti Arifin

Submission Date: 09 Aug 2023

Ref No Claim Type Patient Name Consultation Date Provider Name Receipt No Amount (RM)

910788579 GP Herawaty Binti Arifin 05 Aug 2023 HOSPITAL UMRA RECP00000827 362.20
98
Total: 362.20

Note: Please write down the Ref. No on the receipt and please submit all original document/receipt together with
this cover note..

Printed on: 09 Aug 2023 10:41:43 PM