Professional Documents
Culture Documents
Employee Code :
E S S E N T I A L I T Y C E R T I F I C A T E
(To be filled in Capital Letters)
Name of Claimant _____________________________period of treatment
Designation ___________________From ______________To_____________
Department ___________________Outdoor No. _____________Dt._______
Pay _________________Indoor No. __________________Dt.____________
P.T.O.
Certified that:-
--------------
1. The medicines have actually been purchased by me during the
course of treatment.
2. I am living in House No.______________________________________
3. I have purchased the medicines from the prescribed Co-op store.
4. The medicines have been purchased from private shop after
obtaining non availability certificate from___________________
Co-Op Store/Super Bazar _________________________.
5. The amount of medicines purchased from private shop against one
or more prescription does not exceed Rs.50/-in a single day.
6. In case of wife/children
------------------------
That the patient Mr/Mrs. __________________________________is my
_________________and he/she is solely dependent upon me and is
residing with me at _______________and he/she is unmarried and
un-employed in case of sons/daughters.
7. For parents only
----------------
His/her total monthly income does not exceed Rs.750/-P.M. and
mother/father is/are residing at _______________________.
8. In case spouse is working
-------------------------
a) Certified that my wife/husband is not getting any fixed medical
allowance from any source.
b) Certified that wife/husband is employed and is not getting any
medical reimbursement. An affidavit to this effect has already
been furnished.
c) Certify that I am not adhoc employee and a working on regular
basis.
Employee Code :
E S S E N T I A L I T Y C E R T I F I C A T E
(To be filled in Capital Letters)
Name of Claimant _____________________________period of treatment
Designation ___________________From ______________To_____________
Department ___________________Outdoor No. _____________Dt._______
Pay _________________Indoor No. __________________Dt.____________
Total Amount.31728.80
P.T.O.
Bank Account No. S.B.P. Thermal Plant A/C No.____________________
Employee Code :
E S S E N T I A L I T Y C E R T I F I C A T E
(To be filled in Capital Letters)
Name of Claimant _____________________________period of treatment
Designation ___________________From ______________To_____________
Department ___________________Outdoor No. _____________Dt._______
Pay _________________Indoor No. __________________Dt.____________
Total Amount.
P.T.O.
Bank Account No. S.B.P. Thermal Plant A/C No.____________________
Employee Code :
E S S E N T I A L I T Y C E R T I F I C A T E
(To be filled in Capital Letters)
Name of Claimant _____________________________period of treatment
Designation ___________________From ______________To_____________
Department ___________________Outdoor No. _____________Dt._______
Pay _________________Indoor No. __________________Dt.____________
P.T.O.
Certified that:-
--------------
1. The medicines have actually been purchased by me during the
course of treatment.
2. I am living in House No.______________________________________
3. I have purchased the medicines from the prescribed Co-op store.
4. The medicines have been purchased from private shop after
obtaining non availability certificate from___________________
Co-Op Store/Super Bazar _________________________.
5. The amount of medicines purchased from private shop against one
or more prescription does not exceed Rs.50/-in a single day.
6. In case of wife/children
------------------------
That the patient Mr/Mrs. __________________________________is my
_________________and he/she is solely dependent upon me and is
residing with me at _______________and he/she is unmarried and
un-employed in case of sons/daughters.
7. For parents only
----------------
His/her total monthly income does not exceed Rs.750/-P.M. and
mother/father is/are residing at _______________________.
8. In case spouse is working
-------------------------
a) Certified that my wife/husband is not getting any fixed medical
allowance from any source.
b) Certified that wife/husband is employed and is not getting any
medical reimbursement. An affidavit to this effect has already
been furnished.
c) Certify that I am not adhoc employee and a working on regular
basis.