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  • PacificCross Form

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    Oli Oliver
    5 views4 pages
    This Excel file contains an employee enrollment template for Pacific Cross. It includes fields for the employees' personal details like name, gender, civil status, nationality, date of birth, place of birth, effective date, occupation, employee grade, health plan, maximum benefit limit, PhilHealth coverage, address, email, contact numbers, and beneficiary details. The template is to be filled out by the authorized client representative and submitted to Pacific Cross for employee health insurance enrollment.

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    This Excel file contains an employee enrollment template for Pacific Cross. It includes fields for the employees' personal details like name, gender, civil status, nationality, date of birth, place of birth, effective date, occupation, employee grade, health plan, maximum benefit limit, PhilHealth coverage, address, email, contact numbers, and beneficiary details. The template is to be filled out by the authorized client representative and submitted to Pacific Cross for employee health insurance enrollment.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    5 views4 pages

    PacificCross Form

    Uploaded by

    Oli Oliver
    This Excel file contains an employee enrollment template for Pacific Cross. It includes fields for the employees' personal details like name, gender, civil status, nationality, date of birth, place of birth, effective date, occupation, employee grade, health plan, maximum benefit limit, PhilHealth coverage, address, email, contact numbers, and beneficiary details. The template is to be filled out by the authorized client representative and submitted to Pacific Cross for employee health insurance enrollment.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 4

    CORPORATE ENROLLMENT TEMPLATE (EMPLOYEES)

    (*This Excel file should be completely filled out by the authorized representative of the Client and submitted to Pacific Cross in case individual application form

    Last Name First Name M.I. Gender Civil Status Nationality Birth Date Place of Birth Effective Date

    108198 Canceran Marilyn P Female M Filipino 9-Mar-1984 1/10/2023

    _x000D_ Confidential
    #
    ross in case individual application form is not required.)

    EMPLOYEES TO BE ENROLLED

    PhilHealth
    Occupation/Employee Grade R&B/Plan MBL Address E-mail
    (Y/N)

    B10 L10 Eastview


    Homes 2 Subdivision
    Management and NonUnionized Rank & File Semi-Private 120,000.00 Y
    Brgy. San Roque marilyn.p.canceran@gmail
    Antipolo City 1870

    _x000D_ Confidential
    #
    Name of Beneficiary Birth Date of Relationship to
    Mobile No. Landline No.
    Beneficiary Principal Applicant
    Last Name First Name M.I. Remarks

    9279252027

    ORICA SINGAPORE PTE. LTD. TRUSTEE

    _x000D_ Confidential
    #
    _x000D_ Confidential
    #

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