TIER 3 EMPLOYEE ENROLLMENT FORM
Complete the form to be enrolled in the PenTrust Tier 3 Employee scheme. PenTrust - Retire In Absolute Comfort!
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Email *
1. First Name *
2. Surname *
10. Date of Birth
Age
Sex
Clear selection
Nationality
Marital Status
11. Place of birth (Town, District, Region)
Country of Birth
Permanent Address
Mailing Address
3. Phone number *
4. Email address
Fixed Line
5. ID Type *
6. ID Number *
SSNIT Number
Father's Name *
Father's Address
Mother's Name *
Mother's Address
Previous Employer (If Any)
Previous Contributor Enrollment Number
Nature of Employment
Nature of Income
Annual Basic Salary (GH¢) *
Monthly Basic Salary (GH¢) *
Contribution (GH¢) *
Employer's Name *
Employer's Enrollment Number *
Employer's Address *
Employer's Telephone Number *
13. Next of Kin
14.Next of kin Phone number
15a. Name  of Beneficiary 1
15b. Date of Birth of Beneficiary 1
Phone Number of Beneficiary 1
15c. Relations of Beneficiary 1 to Contributor
15c. Residential Address of Beneficiary 1
15d. Percentage of benefits to beneficiary 1
16a. Name  of beneficiary 2
16b. Date of Birth of Beneficiary 2
16c. Phone number of Beneficiary 2
Relations of Beneficiary 2 to Contributor
Residential Address of Beneficiary 2
16d. Percentage of benefits to beneficiary 2
17a. Name  of beneficiary 3
17b. Date of Birth of Beneficiary 3
17c. Phone number of Beneficiary 3
Relations of Beneficiary 3 to Contributor
Residential Address of Beneficiary 3
17d. Percentage of benefits to beneficiary 3
18a. Name  of beneficiary 4
18b. Date of Birth of Beneficiary 4
18c. Phone number of Beneficiary 4
Relations of Beneficiary 4 to Contributor
Residential Address of Beneficiary 4
18d. Percentage of benefits to beneficiary 4
In place of your signature, kindly type your full, legal name
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