INDIVIDUAL STAFF DECLARATION FORM
EMPLOYER/INSTITUTION………. Visions Africa……………...….…………….…….... TIN…108999429……………
Phone Contact ….…+250784839206…....……….……………….…......………
Email: visionsafricaops@gmail.com……………………………………………...…., Street: KG 684 House 37, Kigali,
Rwanda……………………………………, District: Gasabo………………….…...…………….
Family Name
First Name
National ID Nº
RSSB Registration Nº
Mobile telephone of the staff
Personal e-mail
Father's Names
Mother's Names
Your Physical address
Name of the University attended
Country (Rwanda or Abroad)
Period of study (From……To……)
Course attended/Faculty
Registration Number
Levels of Study (A1/A0/Masters/PhD)
*If more than one, please mention them all
Month in which the staff was employed
Current Gross Salary
Did you benefit from gov't study loan/
bursary? Yes…….../No……
Did you receive a laptop? Yes/No
Have you started to repay/ Yes /No ….... If Yes
in which Organisation/ Institution?
Kindly write your request/Comment
KAMBABAZI
Jeanne
+250784410397
Kambabazijeanne57@gmail.com
MUDAHABA KANDIKO Jean
NYIRANZIZA Peninah
Province: Kigali
District:
Gasabo
Sector:
Kimihurura
Cell:
Kimihurura
Village:
Njamina
Kepler University
Rwanda
2021 t0 2024
Bachelor’s in arts of business management (Logistics and
Operations)
KG21075
A0
November 2023
RWF 247,384
No
Yes
No
I have a full scholarship offered by Kepler program with the
partnership of UNHCR.
Declaration:
I, Jeanne Kambabazi declare that the information provided on this form is true.
Done on the date of: 22/12/2023
Staff Signature:
P.O Box 1341, KN 3 Ave, Kigali – Rwanda | Toll-free 3288/0788388168 | Email: brd@brd.rw | www.brd.rw
Development Bank of Rwanda Plc: A Public Company Limited by Shares; Authorized Share Capital Rwf 150,000,000,000
Company Code: 100003547, SWIFT CODE BRDRRWRW, VAT/TIN: 100003547