OIL & NATURAL GAS CORPORATION LIMITED
MEDICAL REIMBURSEMENT BILL
CPF NO : 00024029 Name SUSHIL KUMAR BANERJEE Submission No:S000387211
Designation:Sr HR Executive Sec/Org Unit: Location:
Treatment Type :OUTDOOR
Sl Name of the Patient Age Relatio Nature of Illness Name of Amount Claimed For Office Use Only
No nship Doctor/Specialist
1 MAMATA BANERJEE Spouse Knee Pain , Knee Pain , Knee Pain , PROF. 6,813.55
59 Knee Pain , N.D.CHATTERJEE ,
Amount Claimed ( in words) Rupees SIX THOUSAND EIGHT HUNDRED THIRTEEN FIFTY FIVE ONLY 6,813.55
Certified that - (a) the claim is as per actual expenditure incurred. Passed for Payment of Rs.
(b) the person for whom expenses have been incurred is dependent on me
Date:12.11.2024 Signature of Employee (Rupees_________________)
Sanctioned subject to admissibility, verification Claim verified and recommended
by M.O or Medical section and pre-audit. for Payment of Rs
Sign. & Seal of
Date:12.11.2024 Sign of Conrtolling Officer Date: Sign I/C Medical Section Finance Ofiicer
Details of enclosed Cash Memos / Receipts
Patient Name Cash Memo Bill Date Bill Amount Subtotal for each
Individual
MAMATA BANERJEE 11696 07.11.2024 1,200.00
1124130518 08.11.2024 2,160.00
1124110210 08.11.2024 350.00
1
13040C50337042:1432 11.11.2024 3,103.55
