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Promise Promissory Note For Hospital Bill
"I need a Promise Promissory Note For Hospital Bill for a cardiac surgery payment of AED 75,000, with the full amount due by March 15, 2025, compliant with UAE law and including standard default provisions."
1. Date and Place of Execution: Specific date and location where the promissory note is executed, which is crucial for legal validity
2. Parties Information: Full legal names, Emirates ID numbers, and addresses of both the promisor (patient/guarantor) and promisee (hospital)
3. Amount Promised: The exact amount promised to be paid, expressed in both numbers and words in AED
4. Payment Terms: Specific date or timeline when the payment is due, including whether it's a single payment or installments
5. Reference to Hospital Services: Brief description of the medical services rendered and associated bill numbers
6. Unconditional Promise Statement: Clear statement of unconditional promise to pay as required by UAE law
7. Signature Block: Space for promisor's signature, with full name and Emirates ID number
1. Guarantor Details: Used when someone other than the patient is promising to pay the bill, including full legal name and Emirates ID
2. Installment Schedule: Include when payment is to be made in multiple installments, detailing the amount and due date of each payment
3. Interest Clause: Optional clause about any applicable interest or late payment charges, if allowed under Sharia principles and agreed upon
4. Witness Details: Section for witness information and signatures when additional verification is desired
5. Language Declaration: Required only if the note is bilingual, stating which language version prevails
1. Schedule A - Hospital Bill Details: Itemized list of hospital services and charges being promised for payment
2. Schedule B - Payment Schedule: Detailed breakdown of installment amounts and due dates, if applicable
3. Appendix 1 - Copy of Hospital Bill: Attached copy of the original hospital bill referenced in the promissory note
4. Appendix 2 - Identity Documents: Copies of Emirates ID or other identification documents of the promisor/guarantor
Authors
Patient
Guarantor
Hospital Services
Due Date
Hospital Bill
Payment Schedule
Medical Services
Principal Amount
Business Day
Default
Emirates ID
Healthcare Facility
Insurance Coverage
Outstanding Balance
Payment Terms
Place of Payment
Treatment Period
Medical Record Number
Authorized Signatory
Payment Terms
Default and Remedies
Patient Information
Hospital Services Reference
Unconditional Payment Obligation
Governing Law
Jurisdiction
Acknowledgment of Debt
Enforcement
Witness Provisions
Guarantor Obligations
Notice Requirements
Amendment
Severability
Execution
Assignment
Language
Interest and Charges
Dispute Resolution
Healthcare
Medical Services
Hospital Administration
Financial Services
Insurance
Legal Services
Healthcare Finance
Medical Billing
Patient Services
Legal
Finance
Patient Services
Revenue Cycle
Medical Records
Compliance
Patient Financial Services
Hospital Administration
Credit Control
Accounts Receivable
Hospital Administrator
Finance Manager
Medical Billing Specialist
Healthcare Financial Analyst
Legal Counsel
Patient Services Manager
Credit Controller
Accounts Receivable Manager
Healthcare Operations Director
Compliance Officer
Revenue Cycle Manager
Patient Financial Services Coordinator
Hospital Legal Administrator
Insurance Coordinator
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