Employee Details
Full Name
Mercy Corps Employee ID
Personal Email
Mobile Number
National ID Number
Date of Birth
Dependent Details (Medical)
If dependent is below 18yrs, Enter N/A for ID Number and your email address as their Personal Email
Full Name
Relationship
Spouse
Son
Daughter
Not Applicable
National ID Number
Mobile Number
Personal Email
Date of Birth
Add Another Dependent
Beneficiary/Next of Kin Details (Group Life)
Details of persons to be contacted / paid in the unfortunate event of your demise. If next of kin is below 18yrs, Enter N/A for ID Number
Full Name
Relationship
Spouse
Son
Daughter
Father(Last Expense)
Mother(Last Expense)
Father-in-law(Last Expense)
Mother-in-law(Last Expense)
Sibling
Other
National ID Number
Mobile Number
Percentage
Add Another Next of Kin
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