Friskvårdsbidrag form

Friskvårdsbidrag Form

(Complete the form then click “Submit”)

(Complete the form then click “Submit”)

ⓘ Note that we will reply to you within 3 working days.

1 ) Add your name and email:

Your name

Email

2 ) Add your personal identity number if your employers require it:

Personal identity number(optional)

3 ) Add the dates of the events you have attended and their receipt: (required)

Event no.1

Event date(required) (YYYY-MM-DD)

Receipt number(required)

Event no.2

Event date(optional) (YYYY-MM-DD)

Receipt number(optional)

Event no.3

Event date(optional) (YYYY-MM-DD)

Receipt number(optional)

4 ) Add the total amount you paid for the receipts added above:

Total amount

5 ) Do you have anything else you would like us to know? add here:

Message(optional)

Declaration (required)

I hereby declare that the information given above is true.

ⓘ Note that these information are not saved anywhere. They are deleted once the matter is resolved.