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  • Health Form

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    Skipper
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    This document contains an employee's personal information including name, designation, department, date of birth, home address, and CNIC number. It also lists any dependents the employee wishes to include in their health insurance coverage, providing each dependent's name, date of birth, sex, relationship to the employee, occupation, and CNIC number. At the end, the employee confirms they want health insurance for themselves and any listed dependents, and agrees to have the premium costs deducted from their monthly salary.

    Original Description:

    Health Insurance

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    © © All Rights Reserved

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    This document contains an employee's personal information including name, designation, department, date of birth, home address, and CNIC number. It also lists any dependents the employee wishes to include in their health insurance coverage, providing each dependent's name, date of birth, sex, relationship to the employee, occupation, and CNIC number. At the end, the employee confirms they want health insurance for themselves and any listed dependents, and agrees to have the premium costs deducted from their monthly salary.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    3 views1 page

    Health Form

    Uploaded by

    Skipper
    This document contains an employee's personal information including name, designation, department, date of birth, home address, and CNIC number. It also lists any dependents the employee wishes to include in their health insurance coverage, providing each dependent's name, date of birth, sex, relationship to the employee, occupation, and CNIC number. At the end, the employee confirms they want health insurance for themselves and any listed dependents, and agrees to have the premium costs deducted from their monthly salary.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    A.

    EMPLOYEE

    Name: Emp No:

    Designation: Joining Date:

    Deptt / SBU: Station:

    Date of Birth: CNIC No:

    Home Address:

    B. DEPENDENTS TO BE COVERED (SPOUSE, CHILDREN, PARENTS)


    ONLY THOSE NAMES BE MENTIONED F OR W HOM H EALTH INSURANCE COVERAGE I S R EQUIRED

    Name Birth Date Sex Relationship Occupation CNIC No

    C. CONFIRMATION BY THE EMPLOYEE

    I wish to seek health insurance coverage for self and above named family members. I will have no
    objection if expenditure involved is deducted from my monthly salary.

    Date: Employee’s Signature:

    [Type here]

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