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Home
| Change of Personal Details Form
Change of Personal Details Form
Select Branch
*
Branch
Head Office
Asylum Down
Achimota
Teshie
Tema
West Hills
Ho
Koforidua
Takoradi
Cape Coast
Techiman
Sunyani
Kumasi
Harper Road Kumasi
Tamale
Bolga
Wa
Yendi
Agona Swedru
Hohoe
Tarkwa
Full Name
*
Policy Number
*
Current Phone Number
*
Email
*
NAME
From Name
To Name
Upload Supporting Document
*
*A change of name should be accompanied by a photocopy of any of the following: i. A sworn affidavit ii. Gazette iii. A newspaper cutting iv. A marriage certificate *A change of name should be accompanied by a photocopy of any of the following: i. A sworn affidavit ii. Gazette iii. A newspaper cutting iv. A marriage certificate
*Kindly attach a valid national ID card to complete process
ADDRESS
From Address
To Address
BENEFICIARY
Delete
ADD
Full Name
Percentage
Date of Birth
Relationship
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Uncle
Aunt
Nephew
Cousin
Niece
Full Name
Percentage
Date of Birth
Relationship
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Uncle
Aunt
Nephew
Cousin
Niece
TRUSTEE
Full Name
Relationship
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Uncle
Aunt
Nephew
Cousin
Niece
Date of Birth
Phone No.
CHANGE OF DEDUCTION
Current Change of deduction Source
Select
Bank
Institution
Cash
Bank Name
Bank Branch
Account No. From
Institution Name
Staff No. From
New Change of deduction Source
Select
Bank
Institution
Cash
Bank Name
Bank Branch
Account No. To
Institution Name
Staff No. To
BENEFIT PERCENTAGE CHANGE (BENEFICIARIES)
Name of Beneficiary
Date of Birth
New Percentage
Name of Beneficiary
Date of Birth
New Percentage
Your Address
Client Signature
*
By ticking, I hereby acknowledge that I have completely read and understand this form and all the information I have provided is correct.
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