Data Collection Form

All fields marked with * are required. Review thoroughly as you cannot edit after submission. However, in the event of a mistake, contact the admin.

Surname *

Other names *

Gender *

Date of Birth *

Business Name *

Business Location *

Year Joined *

Region *

Zone/Chapter *

Phone Number *

Residencial Digital Address (GPS) *

Home Town

Marital Status

Next of Kin's Name

Next of Kin's Number

Mother's Name

Father's Name

Ghana Card Number

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