DISTRICT CODE
*
SECTION 1
SCHEME NAME
*
Please Select
GNAT PROVIDENT FUND SCHEME
NAME OF SCHOOL:
*
DISTRICT:
*
DATE OF EMPLOYMENT
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Day
-
Month
Year
Date
DATE OF JOINING SCHEME
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Day
-
Month
Year
(Date of first deduction)
SECTION 2: PERSONAL DETAILS
NAME
*
First Name
Last Name
DATE OF BIRTH
*
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Day
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Month
Year
Date
GENDER
*
Male
Female
PLACE OF BIRTH:
EMAIL
*
example@example.com
RANK
*
Eg. Asst. Director (please indicate your position)
CURRENT STAFF NO:
*
PREVIOUS STAFF NO.:
SOCIAL SECURITY NUMBER:
*
PHONE NUMBER
*
GHANA CARD NUMBER
*
GHA-XXXXXXXXX-X
POSTAL ADDRESS:
BASIC SALARY (GH¢)
*
Single Spine Monthly Salary
AMOUNT (GH¢)
*
RATE (%)
*
Contribution Rate
SECTION 3: BENEFICIARIES (IN EVENT OF MY DEATH, ANY BENEFITS ACCRUING TO ME UNDER THE FUND SHALL BE PAID TO MY BENEFICIARIES INDICATED BELOW)
NB: Percentage of benefit due to the beneficiary(ies) should add up to 100%
*
NAME OF BENEFICIARY
RELATIONSHIP
% OF BENEFIT DUE TO THE BENEFICIARY
DATE OF BIRTH
CONTACT
1
2
3
4
5
6
7
8
9
10
DECLARATION BY PARTICIPATING EMPLOYEE : I certify that the contents of the membership enrolment form are accurate.
Signature
*
Date
*
-
Day
-
Month
Year
Date
Or Take Photo of Signature
Submit
Should be Empty: