Change of Personal Details Form

Select Branch*
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
*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
Full Name
Percentage
Date of Birth
Relationship
TRUSTEE
Full Name
Relationship
Date of Birth
Phone No.
CHANGE OF DEDUCTION
Current Change of deduction Source
Bank Name
Bank Branch
Account No. From
Institution Name
Staff No. From
New Change of deduction Source
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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No. 3 Mankata Avenue, Behind National Service Secretariat, Airport Residential Area
P.O. Box AN 5783 , Accra – North Ghana

Call on: +233 (0) 302 739605

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