CONTROL.NO:
Bharat Heavy Electricals Limited
Heavy Power Equipment Plant,
Ramachandrapuram, Hyderabad – 502 032
Human Resource Management/Welfare
HR/WLX/RECHS/OPD_CLAIM/2015-16
DATE:
SUB: - CLAIM FORM FOR FIXED OPD EXPENDITURE REIMBURSEMENT UNDER RECHS-REG
REF: CORPORATE HR CIRCULAR NO: 010/PPX/2010 DT: 09.02.2010.
NAME OF THE EX-EMPLOYEE/SPOUSE:
DESIGNATION:
DIVISION-RETIRED:
RESIDENTIAL ADDRESS:
STAFF NO:
SCALE OF PAY: Rs.
BASIC PAY:Rs.
DIVISION-REGISTERED FOR RECHS:
LAND LINE/CELL.NO:
I and my spouse have not availed OPD medical facility at BHEL General Hospital / Panel Hospitals. Accordingly a sum
of Rs.12,000/- (Rupees twelve thousand only) for fixed OPD reimbursement may kindly be reimbursed for the period
from 01.04.2015 to 31.03.2016 which may be credited to my bank account as declared in the NEFT form. Further
certifying that I have renewed my RECHS membership for the financial year 2016 - 17
Signature of Ex-employee/SPOUSE of RECHS
CERTIFICATION OF MEDICAL DEPARTMENT
The applicant and his spouse have not availed OPD Medical facility in our General Hospital / Panel Hospitals for the
period mentioned above.
Chief Medical Services,
BHEL General Hospital.
CERTIFICATION OF HR DEPARTMENT
Verification of Membership validity: 1. VALID AND RECOMMENDED FOR PAYMENT
(subject to condition that he has not claimed OPD Reimbursement)
2. NOT VALID FOR CLAIM
Executive / HR-WLX
FINANCE & ACCOUNTS DEPARTMENT
Passed for Payment of Rs._______/- (Rupees__________________________only) and Paid vide Cheque No:
Dated:
Accounts Supervisor
Note:-
Accounts Executive
Encl: 1. Photostat copy of RECHS medical card valid up to 31.03.2017.
2. NEFT form duly signed by the concerned bank authorities.
3. Submission of fixed OPD claim forms at BHEL, General Hospital from 07/03/2016 to
30/04/2016 at Medical Superientendent/CMO Office.
4. In case Submission by person other than RECHS member – Life certificate in original duly attested by
Gazetted officer with photo must be submitted/enclosed.
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.
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