1. Claim Request Form Л3-53
2. Outpatient card with all particulars filled in – a copy
3. Medical referral and tests results, if expenses for tests have been incurred – a copy
4. A detailed invoice, issued in the name of the Insuree (with description of healthcare services by type and price) and a fiscal receipt, attached to it – an original
5. An official document, containing the Insuree’s bank account, if it has not been indicated in Form ЛЗ 53 – a copy
6. Upon individual insurance:
   - Insurance policy
7. Upon group insurance at the Employer’s expense:
   - Company Certificate from the Employer that the person is insured - an original
8. Upon group insurance at the Insurees’ expense:
   - A copy of the insurance policy and the list of Insurees’ names.

In case the sums will not be received by the eligible person:

Notarized power of attorney from the entitled person, if the sums will be received by another person. The power of attorney must contain a statement (text) that the eligible person has been notified that he is entitled to receive the sums in person.

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