Termination Report

* Company:

Please list Employee Name, Social Security #, and Date of Termination:

NAME SS# DATE

Total Number of Terminations:

If the Employee(s) in an HRA Plan with SABC, please be sure to indicate (HRA) next to their Name above, so that SABC is aware of the HRA Term Date.

If the Employee(s) terminating were participating, please subtract them from your monthly invoice. If the Employee(s) participated for 10 or more days within a month, they are to be included in that months payment. Thank you.

Please feel free to mail: SABC, Inc.
P. O. Box 2449
(Or)
Madison, MS 39130-2449
Email: vgivens@sabcflex.com
Fax: (601) 856-8088

Contact Info
567 Hwy 51. Suite A
Ridgeland, MS 39157

Phone: 601.856.9933
Fax: 601.856.8088
Mailing Address
Southern Administrators and Benefits Consultants, Inc.
P.O. Box 2449
Madison, MS 39130-2449
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Call SABC at 601-856-9933 for Member ID number.
IMPORTANT: Your card is valid for (3) to (5) years. Even if you do not participate for a year, keep your card, until the expiration date. Although it will be inactive, it is still valid for future use. There is a $10.00 charge if the card has to be re-issued.

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