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Employee Information
Names
ID/Passport Number
Job Title
Employee Phone
Employee Email
Employer Information
Name of Establishment
Employer District
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Bugesera
Burera
Gakenke
Gasabo
Gatsibo
Gicumbi
Gisagara
Huye
Kamonyi
Karongi
Kayonza
Kicukiro
Kirehe
Muhanga
Musanze
Ngoma
Ngororero
Nyabihu
Nyagatare
Nyamagabe
Nyamasheke
Nyanza
Nyarugenge
Nyaruguru
Rubavu
Ruhango
Rulindo
Rusizi
Rutsiro
Rwamagana
Employer Phone
Employer Email
Describe the OSH Case
Date of Accident/Desease
Insured to RSSB
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No
Yes
Dispute Description
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