EABL Employee Experience Hub

Medical Scheme Enrolment Form

In order to be enrolled as a member of the East African Breweries Limited Medical Scheme, Union or Management, you are required to give details of yourself and members of your immediate family, namely:

One spouse and four children aged 18 years and below (For children who are between 18 - 25 years and still in school, one must submit a letter from learning institution).
Any changes affecting a member of the family which may arise during your service e.g. divorce; births or deaths should be notified with certified copies to the Human Resources Department by filling in a new form.
Person whose information is not available will not receive medical attention from KBL clinic.

First Name

Date Of Birth

Job Level

Coy No

Job Title

Unit (Hr To Fill)

Id. No.

Department

Location

Mobile No.

Do not add existing dependents if they are already enrolled in the scheme.

Full Name Of Spouse

ID. NO.

Date Of Birth

Full Names Of Children And Date Of Birth

Sex (M)

Signed (Employee)

(F) Date of Birth

Date

Signature:

Date:

Please return the form to the Human Resources Department

Signed(Benefits Advisor)