Summary: ERS Insurance Payment
Keep this portion for your Records.
Date: ___________________
Check #: ________________
Amt: $ _________________
Note: Payment is due on the 1st
day of each month. If payment is
not received, your benefits could
be cancelled.
ERS Insurance Payment
Keep this portion for your Records.
Date: ___________________
Check #: ________________
Amt: $ _________________
Note: Payment is due on the 1st
day of each month. If payment is
not received, your benefits could
be cancelled.
ERS Insurance Payment
Keep this portion for your Records.

Source: Azevedo, Ricardo - Department of Biology and Biochemistry, University of Houston

Collections: Biology and Medicine; Environmental Sciences and Ecology