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Fund mileage form 2026
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- Click ‘Get Form’ to open the fund mileage form in the editor.
- 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.
- In the 'Date' section, input the date of travel. Ensure accuracy as this will affect your reimbursement calculation.
- Fill in the 'Traveled from' and 'Traveled to' sections with complete addresses, including names of medical professionals or facilities visited.
- 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.
- Include any additional expenses such as parking or tolls in their respective sections, attaching receipts where necessary.
- 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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