NBC Ghana Trust Enrolment Form

NBC Ghana Trust Enrolment Form
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Type of Scheme
Employer Name
Employer Name
Employer's Address
Branch/Site/Location
Employer's Telephone Number
Please enter a valid phone number.Format: (233) 000-000000.
Employer's Telephone Number
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 and Family Details
Residential Address
GPS Address
Postal Address
Street Address
Telephone - Home
Please enter a valid phone number.Format: (233) 000-000000.
Telephone - Home
Telephone - Work
Telephone - Work
Please enter a valid phone number.Format: (233) 000-000000.
Email
example@example.com
Father's Name
Father's Contact
Please enter a valid phone number.Format: (233) 000-000000.
Father's Contact
Mother's Name
Mother's Contact
Please enter a valid phone number.Format: (233) 000-000000.
Mother's Contact
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 and Contribution Details
Employee Number / Staff ID
SSNIT Number
Nature of Employment
Previous Employer( If any)
Date of employment
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

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
Please enter a valid phone number.Format: (233) 000-000000.
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%
Phone Number
Please enter a valid phone number.Format: (233) 000-000000.
Should be Empty:

NBC Ghana Trust Enrolment Form

Member Personal Detail

Contact and Family Details

Preferred Mode of Communication

Employment and Contribution Details

Member Declaration

Member Declaration