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HTML Preview Insurance Company Budget page number 1.
1
TRUSTMARK INSURANCE COMP
ANY
ENROLLMENT EXPENSE B
UDGET
WORKSHEET
NAME:
PREP
ARED BY
:
D
A
TE:
CASE NAME:
NUMBER OF ELIGIBLE EMPLO
YEES:
ESTIMA
TED NUMBER OF APPLICA
TIONS:
ESTIMA
TED ANNU
AL PREMIUM:
$
PRODUCT
:
ENROLLMENT D
A
TES FROM:
T
O:
EXPENSES
SALAR
Y
Manager:
Rate
x Days
= $
Enroller:
Rate
x Days
= $
TOT
AL SALAR
Y
$
TRANSPORT
A
TION
Air Fare:
Rate
x # of tickets
= $
Car Rental:
Rate
x Days
= $
Other
TOT
AL TRANSPORT
A
TION
$
LODGING & MEALS
Hotel:
Rate
x Days
x P
eople
= $
Meals:
Da
ys
x P
eople
= $
TOT
AL LODGING & MEALS
$
MISCELLANEOUS
Equipment Rental:
= $
TOT
AL MISCELLANEOUS
$
T
otal Advance Request:
$
Grand
T
otal:
$
Home Office Use Only:
Comments:
Appro
val:
Date:
P485-048
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