GMA STAR FUND ENROLMENT FORM (TIER 3)

SCHEME NAME
CURRENT EMPLOYER:*
DATE OF EMPLOYMENT

DayMonthYear
Date
SECTION 2: PERSONAL DETAILS
NAME*

First NameMiddle Name(s)Last Name
GENDER*

MaleFemale
DATE OF BIRTH*

DayMonthYear
Date
PLACE OF BIRTH:*
EMAIL*
example@example.com
MDC REGISTRATION NUMBER:*
MDC/RN/*****
MDC REGISTRATION NUMBER:*
MDC/RN/*****
STAFF ID:*
PHONE NUMBER:*
NATIONALITY*
GHANA CARD NO.*
SOCIAL SECURITY NUMBER:
POSTAL ADDRESS:
PHYSICAL / DIGITAL ADDRESS:
OCCUPATION
OCCUPATION
CURRENT BASIC SALARY*
For Controller based, Single Spine Monthly Salary excluding all allowances
RATE(%)*
CONTRIBUTION RATE (% of basic salary)
AMOUNT (GHS)*
SECTION 3: BENEFICIARY

BENEFICIARIES (IN EVENT OF MY DEATH, ANY BENEFITS ACCRUING TO ME UNDER THE FUND SHALL BE PAID TO MY BENEFICIARIES INDICATED BELOW). IF BENEFICIARY IS BELOW 18YEARS , KINDLY FILL THE TRUSTEE COLUMN.

SUM OF BENEFICIARY:
The sum of your beneficiaries should add up to 100%.
PROVIDE DETAILS OF PERSON(S) WHO WOULD HOLD THE FUND IN TRUST FOR BENEFICIARIES WHO ARE MINORS
DECLARATION BY PARTICIPATING EMPLOYEE

I certify that the contents of the membership enrolment form are accurate.

	TRUSTEE'S NAME	RELATIONSHIP	DATE OF BIRTH	CONTACT	GPS ADDRESS	EMAIL
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