4. Place of duty . 5. Full residential address.. 6. Name of the Patient and his/her relationship to the Government servants/ Note :- In the case of children, state age also. 7. Place at which the patient fell ill 8. Nature of illness and its duration 9. Details for the amounts/claimed 10. Total amount claimed 11. List of enclosures 12. Countersignature by the controlling officer 1 Inserted in Notification No. DPAR 5 SMR 84 dated: 11th June 1985 Declaration to be signed by the Government.
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How to fill out the Medical Clime Form Vide Rule 151 online
Completing the Medical Clime Form Vide Rule 151 is essential for government servants seeking reimbursement for medical expenses. This guide provides clear instructions to help users fill out the form accurately and efficiently online.
Follow the steps to effectively complete the Medical Clime Form Vide Rule 151.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin filling out the form by entering your name and designation in block letters in the designated field.
- Proceed to specify the office where you are currently employed.
- Input your salary information in the corresponding field.
- Clearly indicate your place of duty in the next section.
- Provide your full residential address to ensure accurate correspondence.
- Next, enter the name of the patient along with their relationship to you, mentioning the age if the patient is a child.
- Indicate the place where the patient fell ill.
- Describe the nature of the illness and its duration in the provided section.
- Fill in the details for the amounts claimed by itemizing any medical expenses incurred.
- Specify the total amount claimed in the appropriate field.
- List any enclosures related to your claim, ensuring all documents are relevant.
- Obtain the countersignature from your controlling officer to validate the form.
- Review all sections for accuracy, then sign the declaration to confirm the truthfulness of your statements.
- Finally, users can save changes, download, print, or share the form as required.
Complete your Medical Clime Form Vide Rule 151 online today to ensure timely processing of your medical expense claims.
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