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Simpang 114 Kuala Belait, Brunei Darussalam 3131 Dear Armin, You have successfully completed your enrollment and your elections have been entered for 2012.
Benefits Confirmation & Summary Date Generated: 11/2/2011 Employee Number: 183919
You acknowledge by your enrollment that you are authorizing the company to deduct from your compensation any required contributions and/or costs of the benefits listed below. Coverage start dates for your benefit elections are listed below; this is the date on which your coverage is effective provided you are actively at work with the company on that date. Your coverage will remain in effect until the next annual open enrollment or until you are able to make a change to your benefits as a result of a qualifying life event or your employment status changes. This will be the only confirmation statement that you receive. You will need to compare this statement to your paycheck. All rates listed on this confirmation statement reflect the per paycheck cost. It is your responsibility to ensure that your benefit elections are deducted from your paycheck correctly.
The rates on this statement do not reflect participation in the Wellness Checkpoint (HRA). Should you choose to participate; the wellness credit will be reflected in your deduction for medical effective January 1, 2012 after the Wellness Checkpoint is completed this year. As a reminder, for 2011, in order to get the Wellness Credit of $10.00 per month, you must complete the Health Risk Assessment Form by November 26, 2011.
Benefits Selections
4,744.25
Covered Dependents These are the dependents you have enrolled in the benefits plans.
Full Name Abonal, Maria Jesusa Almazan Pacia, Arvin Jazen Castro Pacia, Arman Justine Castro Pacia, Armean Benedict Alejandria Abonal, Maria Jesusa Almazan Pacia, Arvin Jazen Castro Pacia, Arman Justine Castro Pacia, Armean Benedict Alejandria
Start Date 15-Aug-2010 15-Aug-2010 15-Aug-2010 15-Aug-2010 15-Aug-2010 15-Aug-2010 15-Aug-2010 15-Aug-2010
Beneficiaries These are the beneficiaries you have named for the plans listed below. To confirm the beneficiary listed on your 401(k) retirement plan, please contact Vanguard directly at 1-800- 523-1188. Plan Name Basic AD&D - Basic AD&D (Int'l) Full Name Pacia, Arvin Jazen Castro Pacia, Arman Justine Castro Pacia, Armean Benedict Alejandria Pacia, Arvin Jazen Castro Pacia, Arman Justine Castro Pacia, Armean Benedict Alejandria National Identifier Relationship Child Child Child Child Child Child Primary % 40.00 30.00 30.00 40.00 30.00 30.00 Contingent % 0.00 0.00 0.00 0.00 0.00 0.00
If you have any questions regarding your benefits, please feel free to contact Patience Norman at pnorman01@slb.com. Regards, Your Benefits Departments