Associate, Family & Parents

Tracking No : D160820231126190681

Employee Details

Employee name Mr Mitesh Mahendrabhai Shinde Emp Id/TPA Id 10092472

Employee's EmailID MITESH.SHINDE@RIL.COM Contact number 8460674929

Employee Bank A/c Information

Account holder name MITESH MAHENDRABHAI SHINDE Bank Name STATE BANK OF INDIA

A/c Number 20*******15 IFSC Code S*********4

Branch Address SHIV***********************************************DARA

Details of the claimant (Patient Details)

Name Shraddha Shinde Relationship Spouse

Claim Details

Nature of illness Pedestrian injured in transport accident Duration of illness 2 Day(s)

Clinic Name Mediassist Clinic Pincode 390011

Treatment Start Date 14-Aug-2023 Total amount 2063

Declaration
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Date Employee Signature

Date of Submission Generated On :- 18 Oct 2023