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Shumbashaba Data Entry Form
First Name
Last Name*
Mobile
ID Number
Passport No.
Reason for care (use "Ctrl" on PC 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
Number of dependents
Street Address
Extension no.
City
Any further information that may be useful
Further information