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On A Cloud
Registration form COLAB Foundation
First Name
Last Name*
Mobile
ID Number
Passport No.
Number of dependents
Are you the head of the household?
Select Value
Yes
No
Gender
Select Value
Male
Female
Age
Select Value
Under 18
18 to 55
Over 55
Reason for care
(hold in CTRL to select more than one)
Unemployed
Lost income as a result of COVID
Persioner/ Elderly
Child Headed Household or Orphans
Chronic Illness/ Disability
Lost your job
A portion of your Salary/ Wage has been cut
Street Address
Extension no.
City
Other information