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[null,"Medical Benefits Scheme"]
[]
[null,"Hello, thank you for downloading our updated electronic R3A Form.  It has been updated"]
[null,"for your convenience.  Please follow the steps outlined below:"]
[]
[null,"1) Select Page01 to start completing your form, filling in the gray areas.  If you do not have"]
[null,"    more than 8 employees, then feel free to print your R3A form as you normally do.  If "]
[null,"    have more than 8 employees, please proceed to step 2. Otherwise, proceed to step 3"]
[]
[null,"2) Each Work Sheet can accommodate up to 8 employees.  Once you have finished"]
[null,"    typing in the information for that sheet, click on the New Page button just below the page"]
[null,"    number in that sheet. It will create a new worksheet for you to enter the information for the "]
[null,"    remaining employees."]
[]
[null,"3) Once you have finished entering all of your employees' information, you may now print"]
[null,"    your worksheet(s).  If you have more than one worksheet of employee information to print,"]
[null,"    ensure you select the appropriate worksheet, then send it to print on your preferred"]
[null,"    printer."]
[]
[null,"4) For your convenience you may save this form under a separate name for your records."]
[]
[null,"::: IMPORTANT NOTES :::"]
[null,"a) Where it says FOR THE MONTH OF, enter the month in question, for example 2022-12-15"]
[null,"    December 15 2022."]
[]
[null,"b) Next to where it says FOR THE MONTH OF, you will notice a 'drop-down' box that says"]
[null,"     Week Ending.  Choose your Week-Ending day.  For example, for most businesses this"]
[null,"     is Friday.  Once you select your Week-Ending day, you will notice the Week-ending dates"]
[null,"    for the said month are automatically entered for you."]
[]
[null,"c) It is important that you specify the AGE-GROUP your employees fall within.  This is to"]
[null,"    ensure the correct contribution amount is calculated. Here are the codes for AGE-GROUP:"]
[null,"        U60    = Employees Under 60"]
[null,"        60-69 = Employees between 60 and 70"]
[null,"        70+    = Employees 70 and over"]
[]
[null,"d) Please click on the Drop down arrow located in the “Age Group” Column to select the"]
[null,"     appropriate Employee Age(Age categories are highlighted in note (C)."]
[]
[null,"e) Please click on the Drop down arrow located in the “M/W” column to select the period "]
[null,"     based on how the Employee is paid(Monthly OR Weekly)"]
[]
[null,"f) For Employees earning less than $100 weekly, the Employer is required to pay the total 7%"]
[null,"    Contribution (this condition applies except where the Employee is between 60-69, the "]
[null,"    contribution that the employer is expected to pay is 2.5% total for the Employee)"]
[]
[null,"g) For Employees earning less than $400 monthly, the Employer is required to pay the total"]
[null,"    7% Contribution (this condition applies except where the Employee is between 60-69, the "]
[null,"    contribution that the employer is expected to pay is 2.5% total for the Employee)"]
[]
[null,"h) Additionally, for employees 70+, no matter the earnings, no contribution is expected."]
[]
[]
[null,"Medical Benefits Scheme"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 1","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
[null,null,null,null,null,"Employer:",null,null,null,null,null,null,null,null,null,"W",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sunday",null,"60-69","Between 60 and 70"]
[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
[null,null,"for the month of:",null,null,null,"2022-12-28",null,"Week Ending",7,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Tuesday"]
["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
[null,null,null,null,"W","Week Ending","Week Ending","Week Ending","Week Ending","Week Ending","Total","Total (Applicable %)","No. of",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Thursday"]
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[null,null,null,null,null,null,"Totals Carried Foward",null,"No. of Employees",{"$f":"COUNTA(B10,B13,B16,B19,B22,B26,B25,B26,B28,B31)","v":0},{"$f":"+K9+K12+K15+K18+K21+K24+K27+K30","v":0},{"$f":"SUM(L9,L12,L15,L18,L21,L24,L27,L30)","v":0},"Total Insurable Earnings"]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"+L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 2","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
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[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
[null,null,"for the month of:",null,null,null,"2022-12-28",null,"Week Ending",7,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Tuesday"]
["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page01!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
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[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page02!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 4","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
[null,null,null,null,null,"Employer:",null,null,null,null,null,null,null,null,null,"W",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sunday",null,"60-69","Between 60 and 70"]
[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page03!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 5","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
[null,null,null,null,null,"Employer:",null,null,null,null,null,null,null,null,null,"W",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sunday",null,"60-69","Between 60 and 70"]
[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page04!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 6","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
[null,null,null,null,null,"Employer:",null,null,null,null,null,null,null,null,null,"W",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sunday",null,"60-69","Between 60 and 70"]
[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,"Totals Carried Foward",null,"No. of Employees",{"$f":"Page05!J33 + COUNTA(B10,B13,B16,B19,B22,B26,B25,B26,B28,B31)","v":0},{"$f":"Page05!K33 + K9+K12+K15+K18+K21+K24+K27+K30","v":0},{"$f":"SUM(L9,L12,L15,L18,L21,L24,L27,L30)","v":0},"Total Insurable Earnings"]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page05!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 7","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
[null,null,null,null,null,"Employer:",null,null,null,null,null,null,null,null,null,"W",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sunday",null,"60-69","Between 60 and 70"]
[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page06!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 8","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
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[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page07!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
[null,null,null,null,null,null,"MONTHLY REMITTANCE FORM",null,null,null,null,null,null,null,"Page 9","F",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending",{"$f":"EOMONTH(G5,-1)+1","v":"2022-12-01"},"U60","Under 60",{"$f":"WEEKNUM(G5,12)-WEEKNUM(DATE(YEAR(G5),MONTH(G5),1),12)+1","v":5}]
[null,null,null,null,null,"Employer:",null,null,null,null,null,null,null,null,null,"W",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sunday",null,"60-69","Between 60 and 70"]
[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page08!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]

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[null,null,null,null,null,null,"MEDICAL BENEFITS SCHEME",null,null,null,null,"Registration No.",null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Week Ending Info","Date Info","Age Group Listing",null,"Week Number"]
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[null,null,null,null,null,"P.O. Box:",null,"Address:",null,null,null,null,null,null,null,"M",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Monday",null,"70+","70 and Above"]
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["PLEASE NOTE THAT EARNINGS EXCLUDE SICK OR MATERNITY LEAVE PAY, SEVERANCE PAY, TRAVELLING & MEAL ALLOWANCE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Wednesday"]
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[null,null,null,null,null,null,"Totals Carried Foward",null,"No. of Employees",{"$f":"Page09!J33 + COUNTA(B10,B13,B16,B19,B22,B26,B25,B26,B28,B31)","v":0},{"$f":"Page09!K33 + K9+K12+K15+K18+K21+K24+K27+K30","v":0},{"$f":"SUM(L9,L12,L15,L18,L21,L24,L27,L30)","v":0},"Total Insurable Earnings"]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"Page09!L34 +L11+L14+L17+L20+L23+L26+L29+L32","v":0},"Total Contribution"]
[]
["Signature of Person Preparing Form",null,null,null,null,null,null,"Position"]