JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
TIER 2 EMPLOYEE ENROLLMENT FORM
Complete the form to be enrolled in the PenTrust Tier 2 Employee scheme. PenTrust - Retire In Absolute Comfort!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
1. First Name
*
Your answer
2. Surname
*
Your answer
10. Date of Birth
Your answer
Age
Your answer
Sex
Male
Female
Prefer not to say
Other:
Clear selection
Nationality
Your answer
Marital Status
Your answer
11. Place of birth (Town, District, Region)
Your answer
Country of Birth
Your answer
Permanent Address
Your answer
Mailing Address
Your answer
3. Phone number
*
Your answer
4. Email address
Your answer
Fixed Line
Your answer
5. ID Type
*
Drivers license
Passport
Ghana Card
Voter's ID
6. ID Number
*
Your answer
SSNIT Number
Your answer
Father's Name
*
Your answer
Father's Address
Your answer
Mother's Name
*
Your answer
Mother's Address
Your answer
Previous Employer (If Any)
Your answer
Previous Contributor Enrollment Number
Your answer
Nature of Employment
Your answer
Nature of Income
Your answer
Annual Basic Salary (GH¢)
*
Your answer
Monthly Basic Salary (GH¢)
*
Your answer
Contribution (GH¢)
*
Your answer
Employer's Name
*
Your answer
Employer's Enrollment Number
*
Your answer
Employer's Address
*
Your answer
Employer's Telephone Number
*
Your answer
13. Next of Kin
Your answer
14.Next of kin Phone number
Your answer
15a. Name of Beneficiary 1
Your answer
15b. Date of Birth of Beneficiary 1
Your answer
Phone Number of Beneficiary 1
Your answer
15c. Relations of Beneficiary 1 to Contributor
Your answer
15c. Residential Address of Beneficiary 1
Your answer
15d. Percentage of benefits to beneficiary 1
10
20
30
40
50
60
70
80
90
100
16a. Name of beneficiary 2
Your answer
16b. Date of Birth of Beneficiary 2
Your answer
16c. Phone number of Beneficiary 2
Your answer
Relations of Beneficiary 2 to Contributor
Your answer
Residential Address of Beneficiary 2
Your answer
16d. Percentage of benefits to beneficiary 2
10
20
30
40
50
60
70
80
90
100
17a. Name of beneficiary 3
Your answer
17b. Date of Birth of Beneficiary 3
Your answer
17c. Phone number of Beneficiary 3
Your answer
Relations of Beneficiary 3 to Contributor
Your answer
Residential Address of Beneficiary 3
Your answer
17d. Percentage of benefits to beneficiary 3
10
20
30
40
50
60
70
80
90
100
18a. Name of beneficiary 4
Your answer
18b. Date of Birth of Beneficiary 4
Your answer
18c. Phone number of Beneficiary 4
Your answer
Relations of Beneficiary 4 to Contributor
Your answer
Residential Address of Beneficiary 4
Your answer
18d. Percentage of benefits to beneficiary 4
10
20
30
40
50
60
70
80
90
100
In place of your signature, kindly type your full, legal name
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of PENTRUST GHANA.
Report Abuse
Forms
