Appendix 'A'
MDINDIA HEALTH INSURANCE TPA PVT. LTD.
HO/Branch : HO Vertical : FACC Name of the Employee : Rahul Anbhore
Emp ID : 9675 Designation : SR. EXECUTIVE
Grade : M2 Salary A/c No. : 967910110004299
Sr. Mode of Amount Name of the Person /
No. Date Conveyance (Local Travel) Travel KM (Rs) Organisation Visited Purpose in Brief with Outcome
TO From
Head Office Anand Hospital & Vighnharta Hospital, Bibwewadi Bike 25 88 Hospital Staff for investigation ofCCN MDI3733117,3740956
1 15/12/2017 Anand Hospital & Vighnharta Hospital, Bibwewadi Rao Nursing Home, Bibwewadi Bike 5 18 Hospital Staff for investigation of CCN MDI3744763
Rao Nursing Home, Bibwewadi Head Office Bike 27 95
Head Office Shree Hospital, Yerawada Bike 4 14 Hospital Staff for investigation ofCCN MDI3749238
Shree Hospital, Yerawada Kedarnath General Hospital & Komal Nursing Home, Vishrantwadi Bike 20 70 Hospital Staff for investigation ofCCN MDI3744864,3751095
2 18/12/2017
Kedarnath General Hospital & Komal Nursing Home, Vishrantwadi Usha Nursing Home, Camp Bike 26 91 Hospital Staff for investigation of CCN MDI3745722
Usha Nursing Home, Camp Head Office Bike 25 88
Head Office Patil Hospital, Handewadi Bike 30 105 Hospital Staff for investigation of CCN MDI3731888
Patil Hospital, Handewadi K G N Health Care Clinic, Sayyad nagar Bike 10 35 Dr. Khan for investigation ofCCN MDI3714956,3714970
3 19/12/2017 K G N Health Care Clinic, Sayyad nagar Sahydri Hospital , Kharadi Bike 8 28 TPA Desk for investigation of CCN 3712518
Sahydri Hospital , Kharadi Agrawal Maternity & General Hospital, Chandan Nagar Bike 10 35 TPA Desk for investigation of CCN 3749377
Agrawal Maternity & General Hospital, Chandan Nagar Head Office Bike 4 14
Head Office Sahydri Hospital, Hadapsar Bike 11 39 TPA Desk for investigation of CCN 3735203,3754986,3754715
4 20/12/2017 Sahydri Hospital, Hadapsar Dhanwantari Hospital, Hadapsar Bike 7 25 Hospital Staff for investigation of CCN 3754715
Dhanwantari Hospital, Hadapsar Head Office Bike 12 42
Head Office Sahydri Hospital, Yerawada Bike 5 18 TPA Desk for investigation ofCCN MDI3761921
Sahydri Hospital, Yerawada Sahydri Hospital, Hadapsar Bike 16 56 TPA Desk for investigation ofCCN MDI3754980
5 21/12/2017 Sahydri Hospital, Hadapsar Ayurveda Rugnalaya, Hadapsar Bike 5 18 TPA Desk for investigation of CCN MDI3595905
Ayurveda Rugnalaya, Hadapsar Nande Hospital, Gadital Bike 5 18 Hospital Staff for investigation of CCN MDI3757832
Nande Hospital, Gadital Head Office Bike 18 63
Head Office Oyester & Pearl Hospital, Shivaji Nagar Bike 20 70 TPA Desk for investigation of CCN MDI3692772
6 22/12/2017 Oyester & Pearl Hospital, Shivaji Nagar Sanchiti Hospital,Shivaji Nagar Bike 5 18 TPA Desk for investigation of CCN MDI3764871,3740296
Sanchiti Hospital,Shivaji Nagar Head Office Bike 15 53
Head Office Medicare Hospital, Hadapsar Bike 10 35 Hospital Staff for investigation of CCN MDI3766012
Medicare Hospital, Hadapsar Pearl Hospital, Sasane Nagar Bike 10 35 Hospital Staff for investigation of CCN MDI3733773
8 27/12/2017
Pearl Hospital, Sasane Nagar Vighnharta Hospital , Undri Bike 18 63 Hospital Staff for investigation of CCN MDI3769223
Vighnharta Hospital , Undri Head Office Bike 22 77
Head Office Sahydri Hospital, Yerawada Bike 5 18 TPA Desk for investigation of CCN MDI3773210,3779155
9 28/12/2017
Sahydri Hospital, Yerawada Head Office Bike 5 18 TPA Desk
Head Office Yash Hospital, Malewadi Bike
Yash Hospital, Malewadi Shreenath Hospital, Ghorpadi Bike Dr.Ingle
10 14/12/2017
Shreenath Hospital, Ghorpadi Patil Hospital,Handewadi Bike Hospital Staff
Patil Hospital,Handewadi Head Office Bike
Head Office Anand Hospital,Bibwewadi Bike Dr. Gundecha
11 15/12/2017 Anand Hospital,Bibwewadi Vighnharta Hospital & Rao nursing Home Bike Dr. Shaikh & Ladda
Vighnharta Hospital & Rao nursing Home Head Office Bike
Total 383 1347
Signature of the Employee : _______________________ Date : ________________
FOR HO USE ONLY
Checked by Approved
RECOMMENDED / NOT RECOMMENDED
MANAGER / HOD Date : ______________
General Manager / Managing Director
Appendix 'A'
HO/Branch : HO
Sr.
Date Conveyance (Local Travel)
No.
TO
Head Office
Sahydri Hospital, Hadapsar
Usha Nursing Home, MG Road
1 31/12/2017
Purohit Hospital, Parvati Gaon
Sharad Hospital,Sinhgad Road
Ruby Hall clinic & N M Wadia, Pune
Head Office
Sahydri Hospital, Yerawada
2 1/1/2018
Columbia Asia, Kharadi
Ruby Hall Clinc, Wanowarie
Head Office
Ganga Nursing Home, Mundhava
3 4/1/2018
Sachi Nursing Home & Endoscopy Centre, Keshavnagar
National Hospital, Kondhawa
Head Office
4 5/1/2018 Columbia Asia, Kharadi
Ram Mangal Sing Heart foundation, Fatima Nagar
Head Office
5 6/1/2018
Noble Hospital, Hadapsar
Head Office
Villoo Poonawala Memorial Hospital,Hadasar
6 8/1/2018
Lotus Hospital, Gadital
Chintamani Hospital, Bibwewadi
Dwarka Hospital, Keshavnagar
Head Office
Noble Hospital, Hadapsar
8 10/1/2018
Inamdar Hospital, Fatima Nagar
Ruby Hall Clinc, Wanowarie
Head Office
9 01-11-2018 Noble Hospital& Sahydri Hospital, Hadapsar
Ram Mangal Sing Heart foundation, Fatima Nagar
Head Office
10 15/1/2018 Columbia Asia, Kharadi
10 15/1/2018
Sahydri Hospita, Yerawada
Head Office
Imax Hospital, Wagholi
Yash Hospital,Malewadi
11 16/1/2018 Lifecare Multispecality Hos & Pearl Hospital, Sasane nagar
Yash Hospital,Malewadi
Vishwraj Hospital, Lonikalbhor
Noble Hospital, Hadapsar
Head Office
Lifecare Multispecality Hospital, Sasane nagar
12 20/1/2018
Yash Hospital,Malewadi
Inamdar Hospital, Fatima Nagar
Head Office
Ruby Hall, Wanowarie
13 22/1/2018 Villoo Poonawala Memorial Hospital,Hadasar
Z Plus Accidental Hospital, Hadapsar
Noble Hospital, Hadapsar
Head Office
14 23/1/2018 Inlaks & Budrani Hospitl, Koregaon Park
Noble Hospital, Hadapsar
15 24/1/2018 Head Office
Sahydri Hospital, Yerawada
Shree Hospital, Yerawada
Jeevan Hospital, Koregaon Bhima
Signature of the Employee : _______________________ Date : ________________
RECOMMENDED / NOT RECOMMENDED
MANAGER / HOD Date : ______________
Appendix 'A'
MDINDIA HEALTH INSURANCE TPA PVT. LTD.
STATEMENT OF CONVEYANCE EXPENSES INCURRED (LOCAL)
Vertical : FACC
Mode of Amount
KM
Travel (Rs)
From
Sahydri Hospital, Hadapsar Bike 14 49
Usha Nursing Home, MG Road Bike 20 70
Purohit Hospital, Parvati Gaon Bike 23 80
Sharad Hospital,Sinhgad Road Bike 15 53
Ruby Hall clinic & N M Wadia, Pune Bike 25 88
Head Office Bike 10 35
Sahydri Hospital, Yerawada Bike 6 21
Columbia Asia, Kharadi Bike 10 35
Ruby Hall Clinc, Wanowarie Bike 18 63
Head Office Bike 22 77
Ganga Nursing Home, Mundhava Bike 13 45
Sachi Nursing Home & Endoscopy Centre, Keshavnagar Bike 5 18
National Hospital, Kondhawa Bike 26 91
Head Office Bike 24 84
Columbia Asia, Kharadi Bike 4 14
Ram Mangal Sing Heart foundation, Fatima Nagar Bike 15 53
Head Office Bike 20 70
Noble Hospital, Hadapsar Bike 13 45
Head Office Bike 13 45
Villoo Poonawala Memorial Hospital,Hadasar Bike 12 42
Lotus Hospital, Gadital Bike 5 18
Chintamani Hospital, Bibwewadi Bike 30 105
Dwarka Hospital, Keshavnagar Bike 27 94
Head Office Bike 13 46
Noble Hospital, Hadapsar Bike 13 45
Inamdar Hospital, Fatima Nagar Bike 8 28
Ruby Hall Clinc, Wanowarie Bike 7 25
Head Office Bike 26 91
Noble Hospital& Sahydri Hospital, Hadapsar Bike 13 45
Ram Mangal Sing Heart foundation, Fatima Nagar Bike 8 28
Head Office Bike 17 60
Columbia Asia, Kharadi Bike 4 14
Sahydri Hospita, Yerawada Bike 10 35
Head Office Bike 6 21
Imax Hospital, Wagholi Bike 12 42
Yash Hospital,Malewadi Bike 20 70
Lifecare Multispecality Hos & Pearl Hospital, Sasane nagar Bike 5 18
Yash Hospital,Malewadi Bike 5 18
Vishwraj Hospital, Lonikalbhor Bike 17 60
Noble Hospital, Hadapsar Bike 19 66
Head Office Bike 13 45
Lifecare Multispecality Hospital, Sasane nagar Bike 16 56
Yash Hospital,Malewadi Bike 5 18
Inamdar Hospital, Fatima Nagar Bike 15 52
Head Office Bike 20 70
Ruby Hall, Wanowarie Bike 25 87
Villoo Poonawala Memorial Hospital,Hadasar Bike 10 35
Z Plus Accidental Hospital, Hadapsar Bike 5 18
Noble Hospital, Hadapsar Bike 5 18
Head Office Bike 13 45
Inlaks & Budrani Hospitl, Koregaon Park Bike 12 42
Noble Hospital, Hadapsar Bike 24 84
Head Office Bike 13 45
Sahydri Hospital, Yerawada Bike 6 21
Shree Hospital, Yerawada Bike 3 10
Jeevan Hospital, Koregaon Bhima Bike 25 87
Head Office Bike 22 77
Total 805 2817
: ________________
MMENDED / NOT RECOMMENDED
AGER / HOD Date : ______________
TPA PVT. LTD.
EXPENSES INCURRED (LOCAL)
Name of the Employee :
Emp ID : 9675
Grade : M2
Name of the Person /
Organisation Visited
TPA Desk
Hospital Staff
Hospital Staff
Hospital Staff
TPA Desk
TPA Desk
TPA Desk
TPA Desk
Hospital Staff
Hospital Staff
Hospital Staff
TPA Desk
TPA Desk
TPA Desk
Hospital Staff
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
Hospital Staff
TPA Desk
TPA Desk
TPA Desk
Hospital Staff
TPA Desk
TPA Desk
TPA Desk
TPA Desk
Hospital Staff
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
TPA Desk
Hospital Staff
Rahul Anbhore
Designation : SR. EXECUTIVE
Salary A/c No. : 967910110004299
Purpose in Brief with Outcome
For investigation of CCN3785805
For investigation of CCN3784226
For investigation of CCN3785219
For investigation of CCN3785844
For investigation of CCN3786250,3784457
For investigation of CCN3775516
For investigation of CCN3788898
For investigation of CCN3777679,3720851
For investigation of CCN3797305
For investigation of CCN3744857
For investigation of CCN3647842
For investigation of CCN3799322
For investigation of CCN3796636
For investigation of CCN3805304,3767667
For investigation of CCN3752603
For investigation of CCN3749319
For investigation of CCN3728728
For investigation of CCN3794829
For investigation of CCN3713117,3577032
For investigation of CCN3761902
For investigation of CCN3802984
For investigation of CCN3807743,3814872
For investigation of CCN3815459
For investigation of CCN3823695
For investigation of CCN 3822675
For investigation of CCN 3828296
For investigation of CCN3806478
For investigation of CCN3709984,3785089
For investigation of CCN3815981
For investigation of CCN3819258
For investigation of CCN3715565,3782152
For investigation of CCN3709984
For investigation of CCN3815981
For investigation of CCN3789945
For investigation of CCN3842666
For investigation of CCN3676732
For investigation of CCN3742221
For investigation of CCN3839810
For investigation of CCN3842082,3832885
For investigation of CCN3843034
For investigation of CCN3816103
For investigation of CCN3817374,3827186
For investigation of CCN3789455
FOR HO USE ONLY
Checked by Approved
General Manager / Managing Director
