| TEMPLATE HEADER | EXPLANATION |
| Company ID | AMF code. Not sure what your AMFCODE is? Either log in to your Ameriflex account (you'll see your AMF code at the top left-hand corner of your screen) or contact your Client Account Manager. |
| Employee Number | Social Security Number, 9 digits, no dashes or spaces. Example: 123456789 |
| FirstName | First Name Only |
| LastName | Last Name Only |
| MiddleInitial | Middle Initial Only, no period necessary. |
| Department | Division or location code. If you don’t have a department, leave this section blank. |
| Benefit Code |
Three letter code for the Plan.
|
| TotalDisbursementAmount | Include the dollar amount of claims to offset the member’s balance. Do not include a $ symbol. |
| Plan Year Start | MM/DD/YYYY |
| Plan Year End | MM/DD/YYYY |