1. Claim Request Form Л3-53 – an original
2. Medical documents for rendered first aid and treatment conducted:
   - discharge summaries
   - outpatient cards
   - interpretation of imaging test results
   - tests, etc.
3. All of the above mentioned medical documents - a copy
4. Actually used sick leave notes:
   - a primary one, the remaining - representing uninterrupted continuations
   - a copy with “True to the Original” inscription, ink-stamped and signed by the Employer
   * For persons with discontinued health insurance rights, as per the Social Security Code, a sick leave note is not to be submitted
5. An official document, containing the heirs’/beneficiary’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 a 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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