CL201433869 UMT Jameel Ahmed Shaikh Zayed Hospital
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February 4, 2014
LETTER ID : PQ_CL_LTR_1001
Accounts Officer
The following Person is covered under Pak-Qatar's Group Health Takaful schemes. You are kindly requested to please extend the bestpossible services/treatment and bill to us for reimbursement as per agreement. Details of Covered Member are as follows:-
Muhammad Nasir Ali SyedAssistant General Manager
Assalam-o-AlaikumDear Accounts Officer
Re : Credit Letter - Jamil Ahmad (University Of Management & Technology)
Pak-Qatar Family Takaful Limited., guarantees the payment to the hospitals on its panel for providing the benefit covered to any of theabove mentioned person, during the validity of this letter (see top right).
BENEFIT NOT COVERED UNDER TAKAFUL SCHEME
- Out Patient Treatment - Charges for meals, phone, laundry and Similar Services. - Mental Illness due to any cause/drug addiction. - Eye glasses, contact lenses, hearing aids & Dentures. - Dental Examination, Extraction & fillings. - Radial Keratomy & Excimer laser procedures. - Cosmetic Surgery, General checkups & rest cures. - Congenital defects & deformities. - Any hospitalization directly or indirectly related to Pregnancy.
Covered Member's Name Jamil Ahmad
Muslim TownLahore
54660Punjab
Letter No CL201433869 / GH200900056641Issued On 04/02/2014 Valid Upto 03/03/2014
For Pak-Qatar Family Takaful Limited
Employee's Signature :
Employee's CNIC No.
Employer's Signature & Seal :
Shaikh Zayed Hospital
Relationship with Employee Self Date of Birth / Age 22-DEC-87 / 26
Identification Number 3630223428723
Participant Name University Of Management & Technology
NOTES FOR THE PREFERRED PROVIDER HOSPITAL1) This letter is valid only for HOSPITALIZATION & DAY CAR SURGERY, ifrecommended by the attending Physician, OUT-Patient treatment, through thisletter is not allowed except MRI & CT Scan.
2) The Preferred Provider (hospital) may entertain the fax copy of this letter dulyattested by the employer,however, the hospital have the right to call for theoriginal in case of any doubt. Hospital should obtain a Pak-Qatar's IdentificationCard/Photo/National Identity Card Identification of the patient.
3) The Preferred Provider hospital is requested to forward their bills with allsupporting documents including copy of CNIC, Pak-Qatar's Identification Cardand copy of this credit letter, to us directly for payment.
4) Preferred Provider (Hospital) is requested to inform Pak-Qatar Family Takafulat phone 021-34311747-56 Ext.153 & 167,(Hotline 0331-8223385), within 24hours of hospitalization of any of the above named Member.
APPROVED LIMIT FOR CURRENT HOSPITALIZATION
Maximum Room and Board Entitlement : Rs. 4,000 per day
Signature:
Rs. 240,000
Employee's Name Identification Number
Jamil Ahmad 3630223428723