Claim Health E Form

👋 Welcome! Are you already part of the Ricky Rampersad Branch family?
📧 Please confirm your email on file
(If your email has changed, just type the new one — we’ll update your record right away.)

Form Checklist

Rows	Yes	No
✍️ Have you signed the claim form?
⏳ Have 90 days or less passed since your claim date?
🧾 Have you attached all receipts?
🩺 Have you included referral letters (if applicable)?

Dear {contactFull}

Thanks for taking the time to fill out and upload the health claim documents. Please allow a 10 working day turnaround time for processing and advise you to use the portal to check for updates

Regards,

Ricky Rampersad

Branch Manager
Please Upload All Documents

Front and back of the claim form, receipts and referral letters if any.
Cancelof
Date

MonthDayYear
Date
Contact: Full Name
Assigned To
Task Type
AGENT: Full Name
Agent Name

First NameLast Name
Agent's Email
example@example.com
Due Date

MonthDayYear
Date
Agent Email
example@example.com
RRB - CLAIMS SUBMISSION DEPARTMENT
Calculation
Should be Empty: