KHUSA Case Submission

HR/Payroll Details

HR/Payroll First Name*

HR/Payroll Last Name*

HR/Payroll Email*

Employee Details

Employee First Name*

Employee Last Name*

Employee Email Address*

Employee Cell Number*

Employee ID/Passport Number*

Employee Payroll Number*

Medical Scheme Select

Category * Select Category Healthcare Retirement

Case Description *

Attachments

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