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Personal Details

First Name

Last Name

Phone Number

Date of Birth

Place of Birth

Nationality

Marital Status

Gender

Religion

Residential Address

GPS Code

Length of Stay at Residence Days Months Years

Residential Status

Rented Owned

Identification

Upload Identification: Ghana Card / Passport Max file size is 2MB

Type of ID: Ghana Card Passport

ID Number

Date of Issue

Date of Expiry

Upload Signature Max file size is 2MB

Employment Details Check if not applicable (i.e Student / Investor)

Name of Employer

Job Title

Payroll Number/Staff Number

Employer Phone Number

Retirement Date (Optional)

Number of Years Employed

Agent Code (Optional)

Relationship Officer Email (Optional)

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Password

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