Associate, Family & Parents

Tracking No : D161220230923459112

Employee Details

Employee name Abhradeep Banerjee Emp Id/TPA Id 508409

Employee's EmailID gowrab.banerjee@gmail.com Contact number 9334622827

Employee Bank A/c Information

Account holder name Abhradeep Banerjee Bank Name AXIS BANK

A/c Number 91***********86 IFSC Code U*********2

Branch Address VOLT*************************UPUR

Details of the claimant (Patient Details)

Name Abhradeep Banerjee Relationship Self

Claim Details

Nature of illness Viral Fever Duration of illness 3 Day(s)

Clinic Name Prasanti Clinic Clinic Pincode 755019

Treatment Start Date 11-Dec-2023 Total amount 1728

Declaration
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Date Employee Signature

Date of Submission Generated On :- 16 Dec 2023