NON DRAWAL CERTIFICATE Certified that the claim of reimbursement of medical expenses incurred by Sri……………………………………………………………………………………… retired/ working as …………………………………………………………………… on his treatment for ……………………..……….... from ……………………..to …………………….. at …………………………Hospitals …………………………... amounting to Rs…………………………… (Rupees ………………………………… ……………………………………………………… Only) was neither preferred nor drawn previously.

Signature and designation

NON DRAWAL CERTIFICATE Certified that the claim of ...

Certified that the claim of reimbursement of medical expenses incurred by. Sri……………………………………………………………………………………… retired/ working as …………………………………………………………………… on his treatment for ……………………..……….... from ……………………..to ……………………..
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