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From Director General Elementary Education, …

FromDirector General Elementary education , haryana , shiksha Sadan, Sector-5, Elementary education Officer, haryana No. 22/33-2013 HR C& V (4)Dated, Panchkula, the 3 3 Sub:- Punjab Medical Attendence Rules, Dependents on State , Wives/SistersPlease refer on the subject cited Punjab Medical Attendence Rules, vide Health Department, HaryanaInstruction HB-II dated , the following documents / affidavits arerequired with Medical Re-imbursement Bills / Claims :Deponent self affidavit in case of self medical re-imbursement claim(Annexure-A).For dependent members medical re-imbursement claims except wife Affidavit& Income Certificate (Annexure-B). The dependent's re-imbursement claimwould be duly verified by the concerned District Elementary education abovee U---Supritendent HRC&VFor Director General Elementary Education, CA haryana , PanchkulaToD:\HRC&V\(4) RANA SIR (4) \ LETIIR - RANA (SELF)I S/o R/o Working as in school District I the above named deponent do hereby solemnly affirm anddeclared as under:-That the depondent is claiming the present medicalreimbursement claim from the neither the deponent has received any claim from anyinsurance in case, any claim/information is found incorrect.

From Director General Elementary Education, Haryana, Shiksha Sadan, Sector-5, Panchkula. Aistrict Elementary Education Officer,ll Haryana State. …

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