The Self Declaration Form For Medical Reimbursement is a standard document used across organizations in Hong Kong to process employee medical expense claims. It is designed to comply with Hong Kong's legal framework, particularly the Personal Data (Privacy) Ordinance and Employment Ordinance. The form is typically used when employees need to claim reimbursement for medical expenses covered under their employment benefits package. It includes detailed sections for personal information, expense documentation, and formal declarations, ensuring proper verification and processing of claims while protecting sensitive personal and medical information. The document serves both as a legal record for audit purposes and as a processing tool for human resources and finance departments.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Genie AI's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
Upload your Doc
1. Personal Information: Declarant's details including name, ID number, employee number, department/position, and contact information
2. Medical Expense Details: Itemized list of medical expenses being claimed, including date of service, healthcare provider details, and amount
3. Payment Information: Bank account or preferred reimbursement method details
4. Declaration Statement: Formal declaration of truthfulness and acknowledgment of consequences for false declarations
5. Privacy Notice: Statement about how the personal and medical information will be used and protected
6. Signature Block: Space for signature, date, and witness signature if required
1. Insurance Coverage Declaration: Section to declare any other insurance coverage that may affect the claim - required if the employee has multiple insurance policies
2. Dependent Information: Details of dependents if the medical expenses are for covered family members - required for family medical benefits
3. Pre-existing Conditions: Declaration of any pre-existing conditions relevant to the claim - required for specific types of medical treatments
4. Third Party Claims: Declaration regarding whether the medical expense was due to third party liability - required for accident-related claims
1. Receipt Checklist: Checklist of required supporting documents and original receipts
2. Medical Certificate: Attachment section for any required medical certificates or doctor's notes
3. Expense Summary Table: Standardized table format for summarizing all claimed expenses
4. Terms and Conditions: Detailed terms and conditions of the medical reimbursement scheme
Relevant legal definitions
Claimant
Covered Dependents
Eligible Expenses
Healthcare Provider
Medical Benefits
Medical Treatment
Original Receipt
Pre-existing Condition
Reimbursement Amount
Supporting Documentation
Treatment Date
Valid Claim
Medical Certificate
Prescribed Medicine
Consultation Fee
Diagnostic Test
Specialist Referral
Insurance Coverage
Third Party Liability
Chinese Medicine Practitioner
Registered Medical Practitioner
Medical Institution
Outpatient Treatment
Inpatient Treatment
Emergency Treatment
Covered Dependents
Eligible Expenses
Healthcare Provider
Medical Benefits
Medical Treatment
Original Receipt
Pre-existing Condition
Reimbursement Amount
Supporting Documentation
Treatment Date
Valid Claim
Medical Certificate
Prescribed Medicine
Consultation Fee
Diagnostic Test
Specialist Referral
Insurance Coverage
Third Party Liability
Chinese Medicine Practitioner
Registered Medical Practitioner
Medical Institution
Outpatient Treatment
Inpatient Treatment
Emergency Treatment
Clauses
Personal Information
Data Privacy
Declaration of Truth
Medical Expense Details
Reimbursement Terms
Supporting Documentation
Payment Details
False Declaration Consequences
Verification Rights
Consent for Data Processing
Record Retention
Documentation Requirements
Dependent Coverage
Third Party Claims
Insurance Coordination
Compliance with Policy
Processing Timeline
Dispute Resolution
Authority to Verify
Acknowledgment
Data Privacy
Declaration of Truth
Medical Expense Details
Reimbursement Terms
Supporting Documentation
Payment Details
False Declaration Consequences
Verification Rights
Consent for Data Processing
Record Retention
Documentation Requirements
Dependent Coverage
Third Party Claims
Insurance Coordination
Compliance with Policy
Processing Timeline
Dispute Resolution
Authority to Verify
Acknowledgment
Relevant Industries
Healthcare
Banking and Financial Services
Technology
Manufacturing
Professional Services
Retail
Education
Public Sector
Insurance
Telecommunications
Construction
Hospitality
Transportation and Logistics
Relevant Teams
Human Resources
Finance
Payroll
Compliance
Legal
Employee Relations
Operations
Administration
Relevant Roles
Human Resources Manager
Benefits Administrator
Compensation and Benefits Specialist
HR Operations Manager
Finance Manager
Payroll Specialist
Compliance Officer
HR Director
Finance Director
Office Manager
Employee Relations Manager
HR Business Partner
Claims Processing Specialist
Benefits Coordinator
Find the exact document you need
Staff Contract Of Employment
Hong Kong employment contract template compliant with local employment laws, establishing terms and conditions of employment.
find out more
Salary Counter Offer Letter
A formal letter under Hong Kong law proposing alternative terms to an initial employment offer, typically focusing on salary and benefits adjustments.
find out more
Safety Assessment Form
A Hong Kong-compliant workplace safety assessment document for systematic hazard identification and risk control under Cap. 509 regulations.
find out more
Objectives For Performance Review
A Hong Kong-compliant document establishing employee performance objectives, evaluation criteria, and assessment timelines.
find out more
Missed SLA
A Hong Kong law-governed document addressing service level agreement breaches, detailing the breach specifics and remediation plans.
find out more
Guardian Consent Letter For Travel
A Hong Kong-compliant legal document providing guardian authorization for a minor's travel, including essential details and consent declarations.
find out more
Trustee Contract
A Hong Kong law-governed agreement establishing trustee duties and responsibilities in managing trust assets and relationships between trust parties.
find out more
Employee Review Form
A Hong Kong-compliant employee performance evaluation document for structured assessment of work performance and professional development planning.
find out more
Self Declaration Form For Job Application
A Hong Kong-compliant self-declaration form for job applications, capturing candidate information and declarations in accordance with local employment laws.
find out more
Declaration Letter For Student
A Hong Kong-governed formal document where students make official declarations regarding their status, circumstances, or intentions within an educational context.
find out more
Declaration Letter For Missing Documents
A formal legal declaration used in Hong Kong to officially document and explain circumstances surrounding lost or missing important documents, governed by Hong Kong's Oaths and Declarations Ordinance.
find out more
Declaration Letter For Employee
A Hong Kong-compliant formal declaration document where employees state their employment circumstances and compliance with company policies under Hong Kong law.
find out more
Guarantor Agreement For Residential Lettings
A Hong Kong law-governed agreement where a guarantor assumes responsibility for a tenant's obligations under a residential tenancy agreement.
find out more
Rent Contract Cancellation Letter
A Hong Kong law-compliant formal notice to terminate a lease agreement between tenant and landlord, including termination details and handover arrangements.
find out more
Landlord Consent To Sublease Letter
A Hong Kong law-governed letter documenting a landlord's formal consent for a tenant to sublease property to a third party, including terms and conditions of the permission.
find out more
Dependant Pass Letter Of Consent
An official Hong Kong Immigration Department document granting employment authorization to dependant visa holders in Hong Kong.
find out more
Declaration For Job Application
A Hong Kong-compliant legal declaration where job applicants formally attest to the truthfulness of their application information and qualifications.
find out more
Student Complaint Letter
A formal document used in Hong Kong's educational system to raise and document student grievances or concerns, following local Education Bureau guidelines and regulations.
find out more
Quality SLA
A Hong Kong law-governed agreement defining measurable service quality standards, performance metrics, and remedies for non-compliance in service delivery.
find out more
Arrival Health Declaration
A mandatory health declaration form required under Hong Kong law for all travelers entering Hong Kong, collecting essential health and travel information for public health monitoring.
find out more
Age Declaration Form
A Hong Kong-compliant legal form for formal declaration of an individual's age, including verification requirements and supporting documentation.
find out more
Affidavit Declaration
A formal sworn statement of facts made under Hong Kong law, authenticated by an authorized person and used as legal evidence.
find out more
Sworn Declaration
A formal legal document made under oath in Hong Kong where an individual declares statements to be true, executed before authorized persons under Hong Kong law.
find out more
Self Employed Contractor Invoice
A Hong Kong-compliant invoice template for self-employed contractors, including service details, payment terms, and tax requirements.
find out more
Cargo Declaration
A mandatory customs document required by Hong Kong authorities for declaring goods being imported, exported, or transited through Hong Kong territory.
find out more
Sworn Affidavit For Passport
A legally binding sworn statement used in Hong Kong for passport-related applications and declarations, executed before authorized officials under Hong Kong law.
find out more
Forklift Risk Assessment
A mandatory safety assessment document under Hong Kong law that evaluates and addresses risks associated with forklift operations in the workplace.
find out more
Self Declaration Form COVID 19
A Hong Kong-compliant form for declaring COVID-19 health status and exposure history, used for public health management and organizational entry requirements.
find out more
Salary Declaration Form
A Hong Kong-compliant form for declaring employee salary and compensation details for tax and statutory purposes.
find out more
Property Damage Waiver Form
A Hong Kong law-governed document that establishes an agreement between parties to waive claims related to property damage under specified circumstances.
find out more
Maintenance Support Agreement
A Hong Kong law-governed agreement establishing terms for maintenance and support services, including service levels, obligations, and pricing.
find out more
House Contract Termination Letter
A formal notice under Hong Kong law for terminating a residential tenancy agreement, specifying termination terms and handover arrangements.
find out more
Driver Contractor Agreement
A Hong Kong law-governed agreement establishing the terms and conditions between a company and an independent driver contractor for providing driving services.
find out more
Declaration Letter For Visa Application
A formal declaration document submitted to Hong Kong Immigration authorities containing legally binding statements supporting a visa application.
find out more
Declaration Deed
A formal legal document under Hong Kong law used to make binding written statements of fact or intention, executed as a deed with proper witnessing requirements.
find out more
Visa Consent Letter For Minors
A Hong Kong-compliant formal letter providing parental authorization for a minor's international travel, including essential details and consent requirements under local law.
find out more
Vendor Contract Termination Letter
A formal notice under Hong Kong law to terminate an existing vendor contract, including termination details and next steps.
find out more
Self Declaration Form For Birth Certificate
A legal declaration form under Hong Kong law for affirming or correcting birth certificate details, governed by the Births and Deaths Registration Ordinance.
find out more
Residency Declaration Form
A formal declaration document used in Hong Kong to officially state and verify an individual's residency status under Hong Kong law.
find out more
Placement Contract Agreement
A Hong Kong-governed agreement between a recruitment agency and client company establishing terms for professional placement services.
find out more
Genie’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; Genie’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)
.png)