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For all types of medical plans and has to be completed by the insured member (Card holder), only if provider is not submitting the claim on his behalf. 3. Use separate form for each Daman member. 4. Please read the form carefully and make sure to complete all pertinent information. Daman will not be able to process any incomplete Claim Reimbursement Form without complete documentation as listed below: Original itemized bill / Invoices with date Original prescription for medication given by .

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