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OPD-Jan 2025

The document is a reimbursement claim form submitted by Mr. M Adil Maneka for medical expenses totaling Rs. 28,843, which includes medicines and consultations for himself, his wife, and his son. The claim lists various types of medical expenses along with their respective dates and amounts. It includes a declaration of the authenticity of the information provided and outlines the necessary approvals and attachments required for processing the claim.

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Muhammad Adil Maneka
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27 views1 page

OPD-Jan 2025

The document is a reimbursement claim form submitted by Mr. M Adil Maneka for medical expenses totaling Rs. 28,843, which includes medicines and consultations for himself, his wife, and his son. The claim lists various types of medical expenses along with their respective dates and amounts. It includes a declaration of the authenticity of the information provided and outlines the necessary approvals and attachments required for processing the claim.

Uploaded by

Muhammad Adil Maneka
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Quaid-e-Azam Thermal Power (Pvt.

) Limited
( OPD Reimbursement Claim Form )
Employee Name : Mr. M Adil Maneka Designation Assistant Manager Contracts
Claim Date : 03/02/25
Sr # Rec # Reimbursement Type Relation Relative Name Bill Date Total Amount

1 35502 Medicines Self Muhammad Adil Maneka 28/01/25 439


2 578253 Medicines Wife Sana Altaf 28/01/25 596
3 1010437 Medicines Wife Sana Altaf 28/01/25 655
4 435 Consultation Wife Sana Altaf 27/01/25 5,000
5 01 Consultation Self Muhammad Adil Maneka 28/01/25 2,500
6 703 Consultation Wife Sana Altaf 27/01/25 4,000
7 1738438 Medicines Self Muhammad Adil Maneka 15/01/25 2,940
8 207109 Medicines Son Muhammad Zaviyar 13/01/25 1,124
9 1729945 Medicines Son Muhammad Zaviyar 09/01/25 750
10 10674 Consultation Son Muhammad Zaviyar 13/01/25 3,500
11 1001193 Medicines Son Muhammad Zaviyar 11/01/25 672
12 1002918 Medicines Son Muhammad Zaviyar 14/01/25 427
13 001250040586Tests Wife Sana Altaf 20/01/25 2,920
14 001250051503Tests Wife Sana Altaf 25/01/25 3,320
Total (Rs.) : 28,843

Declaration
I hereby declare that all information provided and submitted documents with claim form are true and original.

Signature of the Employee Date Recommended By HOD Date

Verified By HR Department Date Approved By GM Admin&HR Date

Paid By Finance Department Date

Recievd By Date

List to be Attached:
* Original Bills Reciepets with date.
* Medical Tests Invoices (Copy) with date & name of patient.

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