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የስብሰባ ጥሪ (AGM) ፤ ግንቦት 17-2016 ዓ.ም ጥዋት 2፡00 ሰዓት
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የተሻሻለ የመመስረቻ ፅሑፍ (MOA)
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Disease To illness Claims Notification Form
Employer
*
Address
Tel No.
*
Woreda
P.O.Box
Policy No(where branch the policy issued)
Activity
Name of the injured person (in full)
*
Date of birth
Category of work
Registration NO. In the insured’s service from
Date of accident
*
Place of accident
*
When was the Employer informed of the accident?
*
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Brief description of the accident
Daily wage Birr
*
Monthly Salary Birr
*
The Employer Witnesses
Name of employer
*
Date
*
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