View Member Record

Division:	00001 - THE DEMO COMPANY
Social Security Number:
Member Name:
Certificate Number:

Member Information

Status:	Effective Date	Coverage Type	Class
	04/01/2000	Member and Family	01
	04/01/1998	Member Only	01

 

Gender:

Male

Date of Birth:

12/12/1972

Date of Hire:

01/15/1998

Occupation:

DRIVER

Address:

501 Ranch Road

City:	LINCOLN	State:	NE	Zip:	68501 -

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Dependent Information

Dependent:

SUSAN J

Relationship:

Spouse

Date of Birth:

01/27/1974

Gender:

Female

Dependent:

JOHN J

Relationship:

Child

Date of Birth:	04/01/2000	Gender:	Male