Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the Cafesalud Incapacidades Liquidadas form and open it in your digital document editor.
2. Fill in the city and date at the top of the form. This information helps identify where the application is being submitted and when.
3. Address the form to the EPS, including their name and the office location, followed by a professional greeting.
4. In the section titled 'Reembolso por Incapacidades y Licencias', clearly state your request for payment concerning the incapacity details.
5. Fill in the type of incapacity and document number associated with the payments being requested. Ensure this information matches the certificates issued by your healthcare provider.
6. Provide the full name of the individual for whom the incapacity is claimed, along with the start date of the incapacity formatted as YYYY/MM/DD.
7. Indicate the type of incapacity by selecting between options such as EG or SOAT, and include the number of the authorizer or incapacity reference.
8. Complete the section with the contributor's data, including the official business name, ID type, identification number, current address, phone number, and email address.
9. In the 'Payment City' and 'Department' section, specify the locations for processing the payment request.
10. Enter the number of pages or documents submitted in the 'Folios' field, and provide contact information for follow-up.
11. If applicable, indicate whether a bank certification is attached by marking 'Yes' or 'No'.
12. Ensure to include your signature and thumbprint in the designated areas. This step verifies your identity for the application.
13. Review the information you entered for accuracy and ensure all relevant documentation is attached before submitting.
14. Upon completing all fields, save your changes, and consider downloading or printing the form for your records.

Begin completing your Cafesalud Incapacidades Liquidadas form online today to ensure a smooth application process.