STAFF FAMILY INFORMATION FORM

Staff Name; __HUMBLE DIDAS______________________________________________

Position: ______COACH_____________________________________________

Duty Station_____KYANGWALI KIKUUBE______________________________________________

Spouse’s Information
Name_____KICONCO TODOZIO__________________________________________________________

Physical Address___KASONGA
KYANGWALI___________________________________________________

Contact____0784137008_________________________________________________________

Spouse Still Alive Yes

Father’s Information
Name_____NGABIRANO DEO__________________________________________________________

Physical Address____KAGOTO KABUYANDA

ISINGIRO_______________________________________________________________

Contact_____0776318580_______________________________________________________________

Father Still Alive Yes

Mother‘s Information
Name__TUSHEMERIRWE
LETICIA______________________________________________________________
Physical Address_____KAGOTO KANYWAMAIZI KABUYANDA
ISINGIRO______________________________________________________________

Contact___________________________________________________________________

Mother Still Alive Yes

BIOLOGICAL SIBLINGS INFORMATION

Number of siblings_____________________________________________

Name Relationship Physical Address/ Mobile Contacts

Residence

ARINEITWE RICHARD BROTHER U.A.E

TWIKIRIZE TEOPISTA SISTER BUKANGA

KAKURU ALEX BROTHER KABALE 0775769595

MUHANGA

KIZA ERIAS BROTHER KABUYANDA 0774089494

ISINGIRO

SUCCESS DENIS BROTHER KABUYANDA 0783113726

ISINGIRO

AYEBARE FRANCIS BROTHER KABUYANDA

ISINGIRO

ANYIJUKIRE GLORIA SISTER MBARARA 0760407918

BRENDA AINEMBABAZI SISTER KABUYANDA

LUCKY JUSTUS BROTHER KABUYANDA

ISINGIRO
 Dependents Information (Only biological)
Name of Dependent DOB Physical Address/ Mobile Contacts
Residence

UNIQUE ANGELLAH 26/03/2013 KASONGA

EXODUS DEOGRATIUS 8/3/2015 KASONGA

ELITE LEONIC 27/6/2022 KASONGA

Emergency contact information.

Full Name__KICONCO TODOZIO______________________________________________

Physical Address/ Residence___KASONGA_______________________________

Primary mobile contact_____0784137008__________________________________

Relationship________WIFE_________________________________________

EMPLOYEE DECLARATION

I……HUMBLE DIDAS……………………………………………………. do consent that, the information given above is

the truth.

Signed: ………………………………………………….

Date: ……2…/2/2023…………………………………………….