To

The DGM(Commnn.)

………………….

Subject: Request for Approval of Time-Barred Medical Claim of amt Rs 1945/-only i.r.o wife of Sh.
abc ,Tech Asst., abc,, XYZ ,Employee no-UUUUU

Dear Sir,

I, XYZ regret that the medical claim of amount Rs 1945/- ( Rs One Thousand Nine
Hundred Fourty Five only) was not submitted within the specified time frame as the
prescription and bills were misplaced.

Despite the delay, I believe this claim is legitimate. I have attached all the required
documents to support my claim, including:

1. A detailed itemized bill from the medical provider.

2. A copy of the medical records and notes related to the treatment.

It is therefore requested to you kindly Consider my case and approve my time barred medical claim
of amount Rs 1945/- only.

Thanking You

Yours faithfully

LXYZ

Employee No-UUUUUU

Tech Asst.

ABC,,BCV ,LOCATION