EMPLOYEE NAVIGATOR ONBOARDING FORM
Company Name
Tax ID
Situs State
Desired Company ID - (unique for each client - company email works great!)
Full Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorizing signing officer for Aflac Master applications (Name, email, and phone)
HR Contact (Name, email, and phone)
Billing Contact (Name, email, and phone)
Payroll frequency (# of insurance deductions throughout the year)
Please Select
Monthly 12
Semi-Monthly 24
Bi-Weekly 26
Bi-Weekly 24
Weekly 52
Weekly 48
Open Enrollment Start Date
-
Month
-
Day
Year
Date
Open Enrollment End Date
-
Month
-
Day
Year
Date
1st Payroll date of the year
-
Month
-
Day
Year
Date
New hire eligibility (1st of the month following ____ days)
Benefits Booklet, Plan Summaries, Plan Cost and Company Contribution
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CLICK TO DOWNLOAD CENSUS TEMPLATE
Attached employee and dependent census
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Requesters email
example@example.com
Agent/Broker
First Name
Last Name
Agent/Broker Splits
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