UNITED SMART PROVIDENT ENROLMENT FORM

UNITED SMART PROVIDENT FUND ENROLMENT FORM

VANGUARD HOUSE #21 INDEPENDENCE AVENUE RIDGE, PMB 108, AIRPORT, ACCRA, GHANA Tel: (233) 20 182 3991 / 20 182 3943
SCHEME NAME: UNITED SMART PROVIDENT FUND SCHEME
COMPANY NAME *
DATE OF EMPLOYMENT *

Day Month Year
Date
SECTION 2: PERSONAL DETAILS
NAME *

First Name Last Name
GENDER *

Male Female
DATE OF BIRTH *

Day Month Year
Date
PLACE OF BIRTH: *
EMAIL *
example@example.com
STAFF ID:
PHONE NUMBER: *
NATIONALITY *
SOCIAL SECURITY NUMBER: *
POSTAL ADDRESS:
PHYSICAL / DIGITAL ADDRESS:
OCCUPATION
NATIONAL ID (prefarably Ghana Card)
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 18 YEARS , KINDLY COMPLETE THE TRUSTEE COLUMN.

NAME OF BENEFICIARY

RELATIONSHIP

% OF BENEFIT DUE TO THE BENEFICIARY

DATE OF BIRTH

CONTACT

TRUSTEE'S NAME

RELATIONSHIP

DATE OF BIRTH

CONTACT/ADDRESS

DECLARATION BY PARTICIPATING EMPLOYEE

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

Clear
Date *

Day Month Year
Date
Should be Empty: