Medical bill Reimbursement Grievance collection form - Social Justice & Special Assistance Department
Employees working under Social Justice & Special Assistance department, Government of Maharashtra, who are facing issues with Medical bill reimbursement can fill this form and register their grievance with the Department so that the Medical Reimbursement case can be managed on priority basis.
Name of the Employee *
Your answer
Designation of the Employee *
Your answer
Employee Seewarth ID *
Please enter valid Seewarth ID of the employee
Your answer
Working with which institution under SJSA Department? *
Please write the exact name of the institution. For example, Ashram School with its proper name and location.
Your answer
Aadhaar Number
Your answer
Medical reimbursement ID *
Please insert the Medical reimbursement ID received at the time of submission of documents
Your answer
Date of submission of the claim *
MM
/
DD
/
YYYY
Mobile Number *
Pl enter correct 10 digit mobile number
Your answer
Email Address
Please enter valid NIC / Government email address
Your answer
Grievance in detail *
Please enter your grievance in detail with all the known information
Your answer
Status *
Please summarize the status of the case. If pending at certain stage, kindly list the reason for pendency.
Your answer
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