PLEASE PROVIDE BELOW INFORMATION CONCERNING BENEFITS YOU ARE INTERESTED IN RECEIVING INFORMATION ON:
We will need salaries and occupations to provide proposals for STD and LTD.
*THIS SECTION ONLY APPLIES TO COMPANIES WITH OVER 50 EMPLOYEES.* If you have more than 50 employees, please click CONTINUE and answer the following questions to the best of your knowledge. If "yes" answered to any, please provide details in "other information" field.
Has any employee or dependent:
Click below to upload your census information. Please remember we will still need the following items: Name, Sex, DOB, Medical Coverage, Occupation and Salary.
FILE UPLOADS: (MAX SIZE 2MB FOR FILES)
YOU ARE NOW FINISHED! PLEASE SUBMIT YOUR FORM AND SOMEONE WITH TRIANGLE INSURANCE & BENEFITS WILL CONTACT YOU SOON.