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    This document is a medical reimbursement form for an Indian Oil Corporation employee named Mr. Shantanu Hazra. It summarizes that Mr. Hazra incurred 10,000 rupees in medical expenses for the purchase of spectacles from Netra Care as prescribed by doctors at KPC Medical College. The form lists two bills for the expenses and includes a declaration by Mr. Hazra that the expenditures were for medically necessary spectacles. It notes the total amount claimed is 10,000 rupees and requires the employee's signature and date.

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    0051790700019_20240109_161541

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    This document is a medical reimbursement form for an Indian Oil Corporation employee named Mr. Shantanu Hazra. It summarizes that Mr. Hazra incurred 10,000 rupees in medical expenses for the purchase of spectacles from Netra Care as prescribed by doctors at KPC Medical College. The form lists two bills for the expenses and includes a declaration by Mr. Hazra that the expenditures were for medically necessary spectacles. It notes the total amount claimed is 10,000 rupees and requires the employee's signature and date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    8 views1 page

    Indian Oil Corporation Limited: Page 1 of 1

    Uploaded by

    aman04pat
    This document is a medical reimbursement form for an Indian Oil Corporation employee named Mr. Shantanu Hazra. It summarizes that Mr. Hazra incurred 10,000 rupees in medical expenses for the purchase of spectacles from Netra Care as prescribed by doctors at KPC Medical College. The form lists two bills for the expenses and includes a declaration by Mr. Hazra that the expenditures were for medically necessary spectacles. It notes the total amount claimed is 10,000 rupees and requires the employee's signature and date.

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    © All Rights Reserved
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    of 1

    Indian Oil Corporation Limited

    Date 06.12.2023 Place 0022

    Employee Name Mr. Shantanu Hazra Employee No. 00517907

    Designation Officer (PC-Mktg),Poly Jharkhand Grade A


    Spouse in IOCL
    Department Petrochemicals No

    Details of Bill(s) Attached

    Doctor's Shop/Vendor Prescription


    Relation Name Bill No. Bill Date Bill Amount
    name Name Date
    self Shantanu Hazra KPC MEDICAL NETRA CARE 20AFMPP5221K1ZI 18.11.2023 Nov 13, 2023 6,000
    COLLEGE AND
    self Shantanu Hazra KPC MEDICAL NETRA CARE 20AFMPP5221K1ZI 18.11.2023 Nov 13, 2023 4,000
    COLLEGE AND

    Declaration:I hereby certify that vide bill No. 20AFMPP5221K1ZI, dated 18.11.2023, I have incurred an expenditure
    of Rs. 10000.00 towards purchase of spectacles as prescribed by above mentioned doctor for myself /
    my medically dependent family members, from the shop - NETRA CARE

    Last approved by Approval date Total claimed amount 10,000

    Employee's
    Date
    Signature

    Page 1 of 1

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