ANNEXURE 1 CONFIDENTIAL JIYO PARSI SCHEME- MEDICAL REIMBURSEMENT FOR FERTILITY TREATMENT-PAID (June 15- Oct 16) S. No Name of Patient Place to which patient belongs Annual Family Income (In Rs.) Name of treating Doctor, Hospital and Address of Hospital Kind of Treatment/ Cycles of treatment Total Cost (In Rs.) Finan cial Assist ance to be provi ded (As per Inco me) Total Paid (In Rs.) Cheque No Date wise No. of Cheque Disbursed Remarks 1 2 3 4 5 6 7 8 9 10 11 12 1 BND Mumbai 6,59,119 Jaslok Hospital, Mumbai Diagnostic, IVF , medicines &Follow-up 75,849 100% 75849 4333101 Dt. 6.6.15 Vijaya Bank N. Delhi 1 Under Treatment 2 AVL Kolkatta 2,16,000 Nova Pulse IVF Clinic Kolkata Diagnostic, IVF, medicine &Follow-up 2,29,045 100% 229045 433106 Dt. 8.6.15 Vijaya Bank N. Delhi 3 Baby born 3 TKI 7,00,000 Isha Hospital, Vadodara Diagnostic, IVF , medicines &Follow up 1,06,212 100% 106212 433108 for Rupees 1,28,071 Dt. 8.6.15 Vijaya Bank N. Delhi 4 Cryofreezing – Embryo Transfer 21,859 100% 21859