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Surname

First name

Other name

Date Of Birth

Age

Gender

Nationality

Marital Status

Permanent Address

Town (Place of birth)

District (place of Birth)

Region (place of Birth)

Mobile Phone number

Fixed Line

Mobile Phone number

Fixed Line

Ghana Card Number

SSNIT Number

Employers's Name

Employers's Enrollment Number

Mailing Address

Next of Kin : First Name

Next of Kin : Other Names

Relationship

Next of Kin : Telephone Number

Name of Beneficiary

Date of Birth

Controller Enrollment Number

Relationship

Permanent Address

Percent of Allocation

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