 |
|
| Identification
Number |
Group
Number |
Effective
Date |
| 123456789* |
|
01/01/2000 |
Members
Name
Sally Smith* |
Members |
|
| * 00
Member first name |
* 02
Member first name |
|
| * 01
Member first name |
* 03
Member first name |
|
 |
|
|
|
 |
| *This
is the Plan Identification number.
|
| *This
is the Employee's name. |
| *This
is information about the Members listed
on the employee's plan, and it includes the Member
names and their Member
number. |
|