Gold Plan Enrolment Form

NBC Ghana Trust Enrolment Form

Please complete it in full
Take Photo / Selfie

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Type of Scheme
Member Personal Detail
Title
First Name
Middle Name
Surname Name
Ghana Card Number
Attach a copy of your Ghana Card ( Front )

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Attach a copy of your Ghana Card ( Back )

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Martial Status
Gender
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Age
Place of Birth
Town
Region
Country of Birth
Nationality
Contact Details
Residential Address
GPS Address
Postal Address
Street Address
Telephone - Home
Please enter a valid phone number.Format: (233) 000-000000.
Telephone - Work
Please enter a valid phone number.Format: (233) 000-000000.
Email
example@example.com
Preferred Mode of Communication
NBC Ghana trust may send you benefit statement, product offering and development in the pension industry via your email address and telephone Please indicate through which media / channel you are permitting us to contact you

( Please tick as appropriate)
Employment Details
SSNIT Number
Nature of Employment
Name of Business
Business Location
Industry Category

Other
Postal Address
Fixed Line
Please enter a valid phone number.Format: (233) 000-000000.
E-mail
example@example.com
Contribution Amount (GH₵)
Amount in Figures
Amount in Words
Option For Payment of Contribution
Frequency of Payment
Withdrawal Option
Service Fees
Maximum fee of 2.5% per annum on the net asset value of the scheme payable to administarto, fund manager , custodian and NPRA
Member Declaration
I hereby confirm that the information provided is correct. I am not a member of any other similar scheme, I am not in possession of another contributor enrolment number, and I am duly informed and to my full understanding that, I will be liable for prosecution for any false declaration herein or hereafter made to the scheme. Additionally, I hereby consent to the deduction of any outstanding liabilities owed to the employer from my provident fund benefits upon exit, in accordance with the scheme rules and applicable law
Member's Full Name
Member's Signature
Member's Declaration Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Beneficiary Nomination Form

Beneficiary Nomination

Rows	Dependant Full Name	Relationship	Telephone	Percentage of Benefit (%)(Sum up to 100%)	Date of Birth	Ghana Card / NHIS / Passport Number	GPS Address	Location	Email
Beneficiary 1
Beneficiary 2
Beneficiary 3
Beneficiary 4
Beneficiary 5
Beneficiary 6
Beneficiary 7
Beneficiary 8
Beneficiary 9
Beneficiary 10

NB:Please note that the total percentage of benefit allocation must equal 100%. If the beneficiary percentage does not add up to 100%, the form cannot be submitted.
Calculation
Next of Kin Full Name
Next of Kin's Contact
Member Declaration
I hereby confirm that the information provided is correct. I am not a member of any other similar scheme, I am not in possession of another contributor enrolment number, and I am duly informed and to my full understanding that, I will be liable for prosecution for any false declaration herein or hereafter made to the scheme. Additionally, I hereby consent to the deduction of any outstanding liabilities owed to the employer from my provident fund benefits upon exit, in accordance with the scheme rules and applicable law
Member's Full Name
Member's Signature
Member's Declaration Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Beneficiary percentage must total 100
Sorry, the beneficiary percentages you entered don't add up to a total of 100%
Should be Empty:

NBC Ghana Trust Enrolment Form

Member Personal Detail

Contact Details

Preferred Mode of Communication

Employment Details

Contribution Amount (GH₵)

Service Fees

Member Declaration

Beneficiary Nomination Form

Member Declaration