Medical Reimbursement Form

Hello Guys, today we are going to upload the Medical Reimbursement Form PDF for you. This form is used by government employees or health policyholders to claim the medical treatment amount. The Income Tax Act allows tax exemption of up to INR 15,000 on medical reimbursements paid by the employer.

Details to be Mentioned in Medical Reimbursement Form PDF

  • Name and Designation of Government Employee
  • Office in which Employed
  • Place of Duty
  • Permanent Address
  • Name of Patient and his/her relation with Government servant
  • Details of amount Claimed
  • Hospital Treatment
  • And any other details

Document Required

  • Medical Reimbursement Application Form
  • Hospital Discharge Summary (Original)
  • Case receipts from hospitals or chemists.
  • Health Card Copy
  • If an accident happens, then FIR or medico-legal certificate(MLC)
  • And any other details.

Here you can download the Medical Reimbursement Form PDF by click on the link given below.

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