Medical Reimbursement Form

   Under this Scheme we help the needy people who are Hospitalized for the disease who are taking treatment but not having insurance and no free of Government Services not able to survive after paying the Hospital Bills, to them we help them as a support in there needy times to survive for them, they can apply for the Medical Reimbursement on or before January 26th and August 15th for every year.

    The Bills will be Process and Reimbursement of selected application will be announce on Every year twice on January 26th and August 15th. The Medical Reimbursement will be announce the selected application who applied with their Medical Bills and details.

PHYSICAL HANDICAPPED

This Scheme is who want to support their Family Not be as a Burden Here we taken an extra step to help the Physical Handicapped – Disable Person to help in there Hard Times to become support to their Family and Build their Self Respect.

The application will be applied with the full details, the details will be rechecked by the team and the process will be done for every year twice on August 15th and January 26th and will announce the selected application and process for further.

They have just to submit their Certificate and Details as Support we will help to provide a VEHICLE/ LAND / SETUP SMALL SCALE BUSINESS, help in related to what they can do.

Reimbursement Application Form - Combined

The Patient is:

📌 Upload Enclosures

Name and Address of the Hospital where Treatment was Carried Out:

DECLARATION

I, am declaring with the above entered information is correct and complete in all aspects. I also declare that neither the patient nor the family claim prior, no assistance has been received. If any fraudulent information is provided, your application will be rejected.

List of Mandatory Enclosures (For Applicant's Reference):

TO BE FILLED IN BY THE TREATING HOSPITAL

Checklist for Reimbursement (For Hospital's Reference):

Enclosures Verification Remarks of Data Entry Operator