ECCCU Membership Application
Full Name:
Date of Birth:
Sex:
Select
Male
Female
Nationality:
Address:
Telephone:
Residential Address:
Email Address:
Occupation:
Workplace:
Marital Status:
Select
Single
Married
Divorced
Name of Spouse:
Spouse Address:
Spouse Contact:
Spouse Occupation:
Spouse Location:
Initial Deposit (GHC):
Shares (GHC):
Account Type:
Select
Regular Savings
Daily Savings
Current Account
Kiddy
Life Saving
Saving Frequency:
Select
Daily
Weekly
Bi-weekly
Monthly
Mode of Saving:
Select
Cash
Cheque
E-Cash
Direct Debit
Require Daily Field Service:
Select
Yes
No
Next of Kin
Next of Kin 1 - Name:
Relationship:
Address:
Custodian:
Next of Kin 2 - Name:
Relationship:
Address:
Custodian:
Signature
Applicant Signature
Sign here
Clear Signature
Date:
Submit Application
Upload Required Documents
Please upload your passport photo and national ID here:
Upload Documents