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Termination Report

* Company:

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


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
Madison, MS 39130-2449
Fax: (601) 856-8088

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