Reimbursement Claim Form" />
Use a Cocolife Reimbursement Claim Form template to make your document workflow more streamlined.
Show details Hide detailsACCIDENT: (Please use extra sheet of paper if needed) 1. State the nature of the incident: □ □ □ □ Road Traffic Accident Cut by substance/device Fire or Explosion Accidental Fall □ □ □ □ Accidents caused by Machinery Hit by a Heavy object/person Nature Disaster/Environmental Others, please specify: ________________________________ 2.1 Date of Accident: ___________________ 2.2 Time of Accident: __________ (□AM/□PM) (MM/DD/YYYY) 3. Place of Accident (give exact address/location).
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