Fund mileage form 2026

1. Click ‘Get Form’ to open the fund mileage form in the editor.
2. Begin by entering the Injured's Name and Claim Number at the top of the form. This information is crucial for processing your reimbursement request.
3. In the 'Date' section, input the date of travel. Ensure accuracy as this will affect your reimbursement calculation.
4. Fill in the 'Traveled from' and 'Traveled to' sections with complete addresses, including names of medical professionals or facilities visited.
5. Calculate round trip mileage and enter it in the designated field. Refer to the provided mileage rates based on your travel dates for accurate calculations.
6. Include any additional expenses such as parking or tolls in their respective sections, attaching receipts where necessary.
7. Finally, sign and print your name at the bottom of the form before submitting it to ensure all information is verified.

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