Alif Industry Human Resource Manual

Prepared by Human Resource Department

Alif Industry Human Resource Manual

MEDICAL REIMBURSEMENT FORM

Name Of Employee Usman Ghani Designation Manager Human Resources

Department Human Resources Location Factory
If Family Member
Relationship with Employee Mother

Prescription of Doctor Attached  Yes  No

Cash Memo / Original Bills Attached  Yes  No
If No, Reasons:

Total Claim (Rs.): Total Rs.10,900_________________________/-

Amount in Words: Rupees Ten Thousand Nibe Hundred Only

Declaration

I hereby declare that the above information submitted is true and does not contain any misrepresentation
and false claim on my part.

_____________________
Signature of Employee
Date:

 Approved  Disapproved
Reasons for Disapproval

____________________________
Signature of Approving Authority
Date:
_______________________
HR Department

Prepared by Human Resource Department