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He Employee Data Sheet

This document is an employee data sheet for a group insurance plan. It requests information such as employee names, sex, occupation, date of birth, annual salary, spouse and child details. The employer contact information is also required. The completed form should be signed and returned to the attention of the Argus Group insurance department.

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fahmi1987
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28 views1 page

He Employee Data Sheet

This document is an employee data sheet for a group insurance plan. It requests information such as employee names, sex, occupation, date of birth, annual salary, spouse and child details. The employer contact information is also required. The completed form should be signed and returned to the attention of the Argus Group insurance department.

Uploaded by

fahmi1987
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Employee Data Sheet

Group Insurance

Name of Employer
Contact Person/Title: Nature of Business:
Tel No and Fax No: Email:

Exact Date of Birth Annual Spouse* D.O.B. Child 1 D.O.B./Sex Child 2 D.O.B./Sex Child 3 D.O.B./Sex
No. Employee Name Sex Class
Occupation (MM/DD/YY) Salary (MM/DD/YY) (MM/DD/YY) (MM/DD/YY) (MM/DD/YY)
E.G. Mr. John Smith M Accountant 12/05/69 50,000 C 10/03/75 NW 05/12/05 M 11/09/09 F 07/14/12 M

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*When completing the SPOUSE information please indicate whether they are Non-Working (NW) or Working Spouse (W) as per the example

Signature of Authorized Employer Representative Date (MM/DD/YY)

Please return to the attention of: Fax No: (441) 295-8421 Email Address:

The Argus Group • 14 Wesley Street, Hamilton HM 11 • P.O. Box HM 1064, Hamilton HM EX • 298-0888 • [email protected] • argus.bm
October 2016 1/1

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