Ghana Medical Association Fund
GMA House, Korlebu-Accra
gmafund@ghanamedassoc.org
www.fund.ghanamedassoc.org
+233-303-965105
GMA Fund | Membership Registration
Provide accurate data to register.
Personal Info:
Full Name
*
First Name
Middle Name
Last Name
Gender
*
Please Select
Male
Female
Select your gender
Address
Street Address
Street Address Line 2
City
State / Province
GhanaPost GPS Code
Phone Number
*
Enter your phone number
Format: (000) 000-0000.
Date of Birth
*
-
Day
-
Month
Year
Enter your date of birth
E-mail
*
Enter your e-mail address
Planned Retirement Age
*
Enter your planned retirement age
Occupation/Specialty
*
Enter your occupation/specialty
Identification:
Your National Identification Details
National ID Number
*
National ID Issue Date
*
-
Day
-
Month
Year
Select your ID issue date
National ID Expiry Date
*
-
Day
-
Month
Year
Select your ID expiry date
Beneficiaries :
Full Name of Beneficiary 1
*
Enter the full name of Beneficiary 1
Beneficiary 1's Mobile Number
*
Enter the mobile number of Beneficiary 1
Relationship
*
Enter the relationship with Beneficiary 1
Beneficiary 1
*
Full Name
Mobile Number
Relationship
Percentage (%)
Beneficiary 2
Full Name
Mobile Number
Relationship
Percentage (%)
Beneficiary 3
Full Name
Mobile Number
Relationship
Percentage (%)
Beneficiary 4
Full Name
Mobile Number
Relationship
Percentage (%)
Employer Info:
Employer (Please tick)
Self-Employed
Government Institution
Private Institution
Name of Institution
Enter the name of the institution your work
Address of Institution
Enter the address of the institution your work
Staff ID
Enter Staff ID
Contributions Info:
Monthly Contributions
GHs 300
Lump sum Contribution
GHs 1000
GHs 2000
GHs 5000
Others
Preferred Payment Mode of Benefit after retirement (Please tick)
50% lump-sum - 50% annuity
100% lump-sum
Date of Registration
-
Day
-
Month
Year
Submit
Should be Empty: