The Human Resources Manager,
___________ (Name Of Company),
___________ (Address)

Date: __/__/____ (Date)

Subject: Request for medical reimbursement

Sir / Madam,

I would state that my name is _________ (Name) and I work at your _________ (Company/ Organization) as ___________ (Manager/ Officer – Mention Designation) of _____________ (Department).

Respected, on ____________ (Date) I got admitted in ___________ (Hospital Name) due to the reason _____________ (Disease Name/ Treatment Name – Mention Reason Of Admission). I was admitted for ________ (Number of days) and I had to pay the bill.

I am writing this letter to request you to reimburse the amount for a total amount of ______ (Reimbursement Amount) as per our company policy. For your reference, I am attaching my reports and bills from the hospital.

For any queries, you may contact me at : _______________ (Contact Number). I shall be highly obliged for your support.

Kind Regards,
______________ (Signature)
______________ (Name),
______________ (Address)

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