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Request for reimbursement of Annual Medical Expenses on undertaking basis
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Dated:
The ............ ................. YYY (City)
Dear Sir / Madam
Regarding :- Reimbursement of Medical Expenses
This is to submit that I have incurred a total amount of Rs. ................ during the period from ......... to ........ towards treatment of myself and my family as detailed hereunder 1. Doctor Consultation Fee Rs. .............. 2. Medicine cist Rs. ............. Total Rs. ............. You are requested to reimburse the expenses as per the policy of the office / bank. Tanking you,
Your faitfully, (Your Name) Designation Employee No. Department / Office Encl: As above.
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