<p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              IN exercise of the powers 
                                              conferred on the Commissioner 
                                              responsible for Finance by section 
                                              44 of the Social Security Decree, 
                                              1972 (N.R.C.D. 127), these 
                                              Regulations are made this 16th day 
                                              of April, 1973.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              PART I&#8212;REGISTRATION</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 1&#8212;Registration of 
                                              Employers.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) Subject to sub-regulation (2) 
                                              of this regulation, every employer 
                                              to whom the Social Security Decree 
                                              (in these Regulations referred to 
                                              as &#8220;the Decree&#8221;), applies shall, 
                                              within thirty days either after 
                                              the date on which these 
                                              Regulations come into force or 
                                              such other date as from which the 
                                              Decree begins to apply to him, 
                                              complete and forward to the Chief 
                                              Administrator Form SS 2 specified 
                                              in the Schedule to these 
                                              Regulations.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) Every employer or worker who, 
                                              immediately before the 
                                              commencement of these Regulations, 
                                              was registered, as employer or 
                                              worker, under the Social Security 
                                              Fund Regulations, 1965 (L.I. 470) 
                                              shall be deemed to be so 
                                              registered under these 
                                              Regulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) An establishment which 
                                              consists of several branches, 
                                              departments, sections, 
                                              sub-offices, depots, stores, 
                                              whether situated in the same place 
                                              or in different places shall for 
                                              purposes of the Decree be deemed 
                                              to be one and the same 
                                              establishment and the Decree shall 
                                              apply to all the workers therein.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 2&#8212;Employer to Notify 
                                              Chief Administrator in Certain 
                                              Cases.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) Every employer referred to in 
                                              sub-regulations (1) and (2) of 
                                              regulation 1 of these Regulations 
                                              who ceases to be an employer to 
                                              whom the Decree applies shall 
                                              inform the Chief Administrator of 
                                              the fact, and the date of his 
                                              ceasing to be such an employer 
                                              within ten days after such date.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (2) Every such employer who 
                                              changes his business address shall 
                                              furnish the Chief Administrator 
                                              with his new address within ten 
                                              days after the change.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 3&#8212;Employer&#8217;s 
                                              Registration Number.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              The Chief Administrator shall 
                                              allot an employer's social 
                                              security registration number to 
                                              every employer from whom he has 
                                              received Form SS 2, and shall 
                                              notify the employer of such 
                                              number. </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 4&#8212;Registration of 
                                              Workers and Voluntary 
                                              Contributors.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (1) Every employer shall, 
                                              immediately after his registration 
                                              and also on his employing a new 
                                              worker, complete and forward Form 
                                              SS 1 specified in the Schedule to 
                                              these Regulations in respect of 
                                              every worker unless the worker 
                                              produces evidence that he is 
                                              already registered under these 
                                              Regulations, or that he is an 
                                              exempt person.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) A voluntary contributor may 
                                              register by completing the said 
                                              Form SS 1 or such other form as 
                                              the Chief Administrator may 
                                              require.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 5&#8212;Certificate of 
                                              Membership.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The original and duplicate 
                                              certificate of membership as 
                                              contained in Form SS 1 shall be 
                                              completed, signed and thumb 
                                              printed, after which the original 
                                              certificate shall be detached and 
                                              delivered by the employer to the 
                                              worker; the duplicate certificate 
                                              shall not be detached.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 6&#8212;Employer to Notify 
                                              Chief Administrator. </span></b>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              An employer shall notify the Chief 
                                              Administrator when a worker ceases 
                                              for any reason whatsoever to be 
                                              employed by him.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 7&#8212;Worker to Complete 
                                              Forms.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Every employer shall require the 
                                              completion of, by every worker of 
                                              his and every such worker shall 
                                              complete, the appropriate parts of 
                                              Form SS 1 specified in the 
                                              Schedule to these Regulations:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Provided that where the worker is 
                                              unable to complete the form 
                                              himself, the worker shall supply 
                                              the employer with the necessary 
                                              particulars for the completion of 
                                              the form.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 8&#8212;Worker to Produce 
                                              Certificate of Membership.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">A 
                                              worker who is already a member of 
                                              the Fund shall produce his 
                                              certificate of membership to each 
                                              new employer or where such 
                                              certificate is lost, he shall 
                                              produce such other evidence of his 
                                              membership and registration number 
                                              as he may possess.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              PART II&#8212;CONTRIBUTIONS</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 9&#8212;Payment of 
                                              Contributions.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The employer shall pay into the 
                                              Fund the contributions prescribed 
                                              under section 27 of the Decree 
                                              within fifteen days after the end 
                                              of the month to which the 
                                              contributions relate.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 10&#8212;Employer Obligated 
                                              Under Decree and Regulations.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) An employer shall be bound by 
                                              his obligations under the Decree 
                                              and these Regulations in respect 
                                              of any period falling before his 
                                              ceasing to be an employer and 
                                              especially his obligations with 
                                              respect to the payment of 
                                              contributions.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) Notwithstanding anything 
                                              stated in sub-regulation (1) of 
                                              this regulation, a person who 
                                              assumes responsibility as an 
                                              employer of an establishment to 
                                              which the Decree applies may be 
                                              held responsible for the payment 
                                              of any contributions or other 
                                              moneys due to the Fund and the 
                                              submission of any documents to the 
                                              Chief Administrator in respect of 
                                              which the previous employer was in 
                                              default.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 11&#8212;Manner of Payment.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The payment of contributions and 
                                              other moneys due to the &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Fund shall be made in one of the 
                                              following ways&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; text-indent: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) in cash to be paid&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">

                                              <span style="font-family: Arial">(i) 
                                              at the Head Office of the Trust; 
                                              or</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (ii) into the account of the Fund 
                                              at any branch of the Ghana 
                                              Commercial Bank;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) by money order, postal order, 
                                              crossed cheque bearing the words 
                                              &quot;A/C Payee only&quot; or draft drawn on 
                                              any Bank in Ghana made payable to 
                                              the Fund and delivered or mailed 
                                              to&#8212;</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">(i) 
                                              the Head Office of the Trust and 
                                              such other offices as the Board 
                                              may direct;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (ii) any branch of the Ghana 
                                              Commercial Bank; or</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) in such other manner as the 
                                              Chief Administrator may from time 
                                              to time authorise in any 
                                              particular case or class of cases.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 12&#8212;Payment of 
                                              Contributions Accompanied by Form 
                                              SS 3</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) All payments of contributions 
                                              to the Fund shall be accompanied 
                                              by form SS 3 duly completed or by 
                                              such other forms as the Chief 
                                              Administrator may authorise in 
                                              writing. </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) An employer may make one 
                                              consolidated payment for all his 
                                              establishments, including the 
                                              branches, sub-offices, depots, 
                                              provided separate contributors' 
                                              lists are furnished in respect of 
                                              each branch, sub-office, depot, 
                                              and the amounts in respect of each 
                                              such unit are distinctly 
                                              indicated.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 13&#8212;Contributions 
                                              Return.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) At the end of the contribution 
                                              period or such other period as may 
                                              be authorised by the Chief 
                                              Administrator, an employer to whom 
                                              the Decree applies shall furnish 
                                              to the Chief Administrator a list 
                                              of contributors.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The list of contributors 
                                              referred to in sub-regulation (1) 
                                              of this regulation shall show&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (a) the names and registration 
                                              number of each worker;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) the worker's pay;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) the contribution deducted from 
                                              his pay;</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (d) the employer's contribution in 
                                              respect of that worker; and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; text-indent: 36.0pt">
                                              <span style="font-family: Arial">
                                              (e) the total of all contributions 
                                              due to the Fund over the period.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 14&#8212;Official Receipts 
                                              Required for Payments.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              No receipt other than the official 
                                              numbered receipt date-stamped and 
                                              endorsed shall be deemed to be a 
                                              sufficient discharge for payment 
                                              in respect of contributions and 
                                              other moneys: </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Provided that a Bank 
                                              paying-in-slip, impressed with the 
                                              teller's stamp and initialled by 
                                              him, may be deemed a sufficient 
                                              discharge for payment unless the 
                                              amount paid to the Bank is never 
                                              credited to the Fund Account at 
                                              the Ghana Commercial Bank, High 
                                              Street Branch, Accra.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 15&#8212;Earlier Payment of 
                                              Contributions in Certain Cases.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              The Chief Administrator may 
                                              require an employer to pay the 
                                              contributions in respect of a 
                                              worker earlier than the date 
                                              prescribed by regulation 9, and in 
                                              a manner other than that 
                                              prescribed by regulation 11, in 
                                              order that the Trust may make an 
                                              expeditious payment of a benefit 
                                              due.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 16&#8212;Refund of 
                                              Contributions and Other Payments 
                                              not Due.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (1) Where the Chief Administrator 
                                              is satisfied that any amount has 
                                              been paid to the Fund which was 
                                              not due, he may, subject to the 
                                              provisions of this regulation 
                                              refund the amount to the person 
                                              entitled to it:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Provided that no refund shall be 
                                              made where the member of the Fund 
                                              or his dependants have already 
                                              been paid out the amount as 
                                              benefit.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The Chief Administrator may 
                                              withhold the whole or any part of 
                                              the excess and offset it against 
                                              any amount due to the Fund from 
                                              the person to whom the excess 
                                              would otherwise have been paid.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) The Chief Administrator may 
                                              require the person who made the 
                                              excess payment to make a written 
                                              application for refund and to 
                                              furnish such information as the 
                                              Chief Administrator may require to 
                                              determine the amount of the excess 
                                              payment and the circumstances in 
                                              which it occurred.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 17&#8212;Record of Pay.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              An employer to whom the Decree 
                                              applies shall keep records of pay, 
                                              showing, in respect of every 
                                              worker, the name of the worker, 
                                              the Worker's Social Security 
                                              Number, the pay of the worker as 
                                              defined in the Decree, and the 
                                              deduction for contribution to the 
                                              Fund.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 18&#8212;Preservation of 
                                              Record.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The employer shall preserve the 
                                              record referred to in regulation 
                                              17 for twelve years after the end 
                                              of the period to which the pay 
                                              relates.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 19&#8212;Employer&#8217;s Record of 
                                              Contributions.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Trust shall maintain for each 
                                              employer a record showing 
                                              contributions paid by him, and 
                                              those due from him.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 20&#8212;Members&#8217; Record.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Trust shall maintain in 
                                              respect of each member a record&nbsp; 
                                              of contributions paid by and on 
                                              behalf of the member plus interest 
                                              and less any benefits paid and 
                                              other authorised deductions.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 21&#8212;Members&#8217; Annual 
                                              Statement of Account.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Trust at the end of each year, 
                                              shall furnish to the employer of 
                                              each member and the employer shall 
                                              transmit to the member an annual 
                                              statement showing the 
                                              accumulations in the Fund at the 
                                              credit of the member.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              PART III&#8212;BENEFITS</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 22&#8212;Application for 
                                              Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              An application for a benefit shall 
                                              be made on the appropriate form 
                                              and delivered to the Chief 
                                              Administrator. </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 23&#8212;Superannuation 
                                              Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) An application for 
                                              superannuation benefit shall be 
                                              made on Form SS 4, specified in 
                                              the Schedule to these Regulations.
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (2) The date of birth of a member 
                                              entered in the records of the 
                                              Trust shall be deemed to be 
                                              correct unless the Chief 
                                              Administrator has reason to 
                                              believe that such date was not 
                                              correctly stated.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) Where the Chief Administrator 
                                              believes that the date of birth of 
                                              a member has not been correctly 
                                              stated he may:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) ask to be furnished with 
                                              further evidence of age; and</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) substitute what he considers 
                                              to be the correct age.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (4) The applicant's claim of 
                                              retirement must be supported by 
                                              the employer's certificate:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Provided that the Chief 
                                              Administrator may dispense with 
                                              this certificate and accept other 
                                              evidence in support of the 
                                              applicant's claim that he has 
                                              retired from employment.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (5) The benefit shall not be 
                                              authorised unless the member has 
                                              reached the age of superan-nuation.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 24&#8212;Invalidity Benefit.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              An application for an invalidity 
                                              benefit shall be made on Form SS 
                                              4, specified in the Schedule to 
                                              these Regulations which shall be 
                                              endorsed by the employer and the 
                                              medical officer and forwarded to 
                                              the Chief Administrator.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 25&#8212;Survivor&#8217;s Benefit.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) An application for survivor's 
                                              benefit shall be made on Form SS 
                                              5, specified in the Schedule to 
                                              these Regulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The applicant shall produce 
                                              with his application:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (a) a certificate or other 
                                              evidence of the death of the 
                                              member; and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) except where the applicant has 
                                              been nominated as a beneficiary, 
                                              Letters of Administration; or</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) where the amount claimed is 
                                              two hundred cedis or less an 
                                              affidavit or statutory declaration 
                                              establishing the applicant's 
                                              identity and his relationship to 
                                              the deceased.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 26&#8212;Emigration Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              An application for emigration 
                                              benefit shall be made on Form SS 
                                              6, specified in the Schedule to 
                                              these Regulations, and shall be 
                                              supported by statutory declaration 
                                              that the member has emigrated or 
                                              is about to emigrate from Ghana.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 27&#8212;Sickness Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) An application for sickness 
                                              benefit shall be made on Form SS 
                                              7, specified in the Schedule to 
                                              these Regulations and shall be 
                                              submitted to the Chief 
                                              Administrator through the 
                                              employer.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The employer's certificate and 
                                              the medical certificate appearing 
                                              on the said form shall be 
                                              completed by the employer and a 
                                              medical practitioner respectively.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) The Chief Administrator may 
                                              refer the member for another 
                                              medical examination by a medical 
                                              practitioner specified by him and 
                                              may use the report of such medical 
                                              practitioner as evidence in 
                                              deciding the member's claim to the 
                                              benefit.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (4) The rate of sickness benefit 
                                              to be paid shall be as follows:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a)&nbsp; a flat rate of 40 pesewas per 
                                              day for a worker receiving &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              not more than 99 pesewas per day;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (b) a flat rate of 50 pesewas per 
                                              day for a worker receiving not 
                                              less than 1 cedi and not more than 
                                              1 cedi 29 pesewas per day;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) a flat rate of 60 pesewas per 
                                              day for a worker receiving not 
                                              less than 1 cedi 30 pesewas per 
                                              day.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (5) Sickness benefit shall not be 
                                              payable for a period exceeding 
                                              twenty-six weeks.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 28&#8212;Life Insurance 
                                              Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) The Chief Administrator shall 
                                              transfer each month into a Life 
                                              Insurance Account, one per centum 
                                              of the worker's pay or any other 
                                              percentage as may be determined by 
                                              the Board to have the life of each 
                                              member of the Fund insured 
                                              throughout the period of his 
                                              membership.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The Chief Administrator shall, 
                                              where a member dies before the 
                                              payment of his accumulations in 
                                              the Fund, pay to the nominee or 
                                              nominees of the member, in the 
                                              proportion determined by the 
                                              member for payment of his 
                                              accumulations in the Fund, a life 
                                              insurance benefit equal to twelve 
                                              month's pay of the member as 
                                              calculated at the rate of such pay 
                                              in force at the time of his death 
                                              or any other amount as may from 
                                              time to time be determined by the 
                                              Board.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) The Life Insurance Benefit 
                                              shall not be treated as lapsed 
                                              during a period not exceeding 
                                              twelve calendar months when 
                                              contributions on behalf of the 
                                              member are not received in the 
                                              Fund due to any cause whatsoever, 
                                              including his non-employment in an 
                                              establishment to which the Decree 
                                              applies.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 29&#8212;Chief Administrator 
                                              to Direct Payment of Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Notwithstanding anything in this 
                                              Part, the Chief Administrator may, 
                                              after such enquiry as he may deem 
                                              necessary, pay the to amount of 
                                              the benefit, if it does not exceed 
                                              four hundred cedis, to the person 
                                              or persons whom he considers best 
                                              entitled to it and no claim from 
                                              any other person shall lie against 
                                              the Fund in respect of such 
                                              payment.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 30&#8212;Applicant for 
                                              Benefit to Make Statutory 
                                              Declaration or Affidavit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Chief Administrator may 
                                              require any person who has made an 
                                              application for a benefit to make 
                                              a statutory declaration or 
                                              affidavit as to the truth of any 
                                              statement of fact made by him in 
                                              the application or in support of 
                                              any evidence adduced by him.
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 31&#8212;Chief Administrator 
                                              may Authorise Certain Officers to 
                                              make Inquiry.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Chief Administrator may 
                                              authorise any officer of the 
                                              Ministry responsible for Pensions 
                                              and National Insurance or 
                                              organised labour or the Ministry 
                                              responsible for Labour or the 
                                              Trust to make inquiry about any 
                                              application for a benefit, or to 
                                              make use of any Government, local 
                                              authority or other record as 
                                              evidence for purposes of these 
                                              Regulations. </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 32&#8212;Payment of Benefit 
                                              or Refund of Contributions.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The payment of a benefit or the 
                                              refund of contributions duly 
                                              authorised shall be made by the 
                                              Chief Administrator in cash, or by 
                                              means of a cheque, money order, or 
                                              postal order, or by such other 
                                              means as the Chief Administrator 
                                              may think fit in any particular 
                                              case. </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 33&#8212;Acknowledgement of 
                                              Receipt of Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">A 
                                              receipt in Form SS 10 specified in 
                                              the Schedule to these Regulations 
                                              for the amount of benefit paid 
                                              from the Fund shall be given by 
                                              the payee to the Chief 
                                              Administrator. </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">

                                              Regulation 34&#8212;Conversion of 
                                              Benefits into Pension Account.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Commissioner may, in 
                                              consultation with the Trust direct 
                                              that the benefits, with the 
                                              exception of the sickness benefit, 
                                              payable under these Regulations, 
                                              instead of being paid as a lump 
                                              sum, be converted into a pension 
                                              account and payments be made by 
                                              instalments periodically to the 
                                              member, or if he dies to his 
                                              nominees or heirs, as the case may 
                                              be, or that the amount may be paid 
                                              partly as a lump sum and partly by 
                                              periodical instalments.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">

                                              Regulation 35&#8212;Payment through the 
                                              Post.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The posting of a registered letter 
                                              containing an instrument of 
                                              payment sent in pursuance of these 
                                              Regulations and addressed to the 
                                              person concerned at the address 
                                              furnished on the application form, 
                                              shall, as regards the liability of 
                                              the Trust, be equivalent to the 
                                              delivery of the instrument of 
                                              payment to the person to whom the 
                                              letter was addressed:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Provided that where the Chief 
                                              Administrator is satisfied that 
                                              such an instrument of payment has 
                                              not, for any reason, been received 
                                              by the payee, he may on receipt of 
                                              a duly executed indemnity to the 
                                              Trust issue a duplicate instrument 
                                              of payment.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 36&#8212;Minors and Persons 
                                              of Unsound Mind or Other 
                                              Disability.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) Where a member or his 
                                              survivor, entitled to a benefit or 
                                              refund under the Decree or under 
                                              these Regulations, is a minor, or 
                                              of unsound mind or suffering from 
                                              any other disability rendering him 
                                              unfit to manage his own affairs, 
                                              anything required to be done by 
                                              him, may be done on his behalf by 
                                              any person appointed by order of 
                                              the High Court or other court of 
                                              competent jurisdiction or under 
                                              customary law and any amount 
                                              payable to that person may be paid 
                                              to the person appointed to 
                                              administer his affairs in 
                                              accordance with the order of the 
                                              Court or under customary law.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) Where the Chief Administrator 
                                              is satisfied that no such person 
                                              has been appointed by the court or 
                                              under customary law he may, if he 
                                              thinks fit, and the money in the 
                                              Fund due or payable to the member 
                                              or survivor does not exceed the 
                                              sum of two hundred cedis, approve 
                                              payment of the amount or any part 
                                              thereof, to any other person who 
                                              satisfies him that he is a proper 
                                              person to receive the amount on 
                                              behalf of the person entitled 
                                              thereto, and win apply the amount 
                                              for the maintenance and benefit of 
                                              that minor or person of unsound 
                                              mind or other disability. </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) Any receipt given under this 
                                              regulation shall be a good and 
                                              sufficient discharge to the Trust 
                                              for the amount paid.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              PART IV&#8212;FINANCE AND ACCOUNTS</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 37&#8212;Investment.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (1) The corpus of the Fund shall 
                                              be invested in loans of the 
                                              Government of Ghana and other 
                                              securities in accordance with 
                                              section 3 (b) of the Decree.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) A statement shall be published 
                                              each month showing &#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) the total amount invested;</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) the securities and loans in 
                                              which it is invested; and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) the benefits paid up to the 
                                              end of the preceding month</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 38&#8212;Moneys to be Paid 
                                              into the Reserve Fund.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The following amounts, subject to 
                                              such additional amounts as may be 
                                              determined by the Commissioner in 
                                              consultation with the Board, may 
                                              be paid into the Reserve Fund:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (a) the whole or part of the 
                                              interest realized from employers 
                                              under section 28 of the Decree on 
                                              delayed payments of contributions;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) such sum as may be allocated 
                                              by the Commissioner in 
                                              consultation with the Board, from 
                                              the undistributed balance of 
                                              income from investment;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) fee for a Duplicate 
                                              Certificate of Membership paid by 
                                              a member in the event of loss of 
                                              the original;</span></p>

                                              <p class="MsoNormal" style="text-align: justify; text-indent: 36.0pt">
                                              <span style="font-family: Arial">
                                              (d) unclaimed amounts of 
                                              contributions;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (e) any other moneys received by 
                                              the Chief Administrator which have 
                                              not been allocated to any purpose 
                                              by the Decree or by these 
                                              Regulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 39&#8212;Moneys to be Paid 
                                              Out of the Reserve Fund.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The following amounts may be paid 
                                              out of the Reserve Fund:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (a) unclaimed money previously 
                                              transferred to the Reserve Fund 
                                              and subsequently claimed by any 
                                              person who can&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">(i) 
                                              show a legal title thereto within 
                                              a period of six years from the 
                                              time of its transfer to the 
                                              Reserve Fund; and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (ii) give such indemnity to the 
                                              Fund as the Chief Administrator 
                                              may require;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">

                                              <span style="font-family: Arial">
                                              (b) ex gratia payments authorised 
                                              by the Commissioner;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) subventions to interest 
                                              account to maintain the level of 
                                              interest to members; and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (d) any other payments which the 
                                              Commissioner considers 
                                              appropriate.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 40&#8212;Annual Report.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) The Board shall, not later 
                                              than six months after the end of 
                                              each financial year submit to the 
                                              Commissioner, an annual report 
                                              including a Balance Sheet and a 
                                              full statement of investments, on 
                                              the operation of the Fund in that 
                                              year.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The report, which shall be 
                                              placed before the National 
                                              Redemption Council by the 
                                              Commissioner, shall be in 
                                              sufficient detail to indicate&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) the working of the scheme;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (b) the difficulties (if any) 
                                              encountered;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) an estimate of amounts due but 
                                              not realized;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (d) number of cases in which legal 
                                              action was taken by prosecution 
                                              and for the realisation of unpaid 
                                              amounts as debts owed to the 
                                              Trust;</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (e) the number of cases of payment 
                                              of benefits of each type and the 
                                              amounts so paid;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (f) any amendments which in the 
                                              opinion of the Board should be 
                                              made to the Decree or to these 
                                              Regulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 41&#8212;Audit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Auditor-General or any auditor 
                                              appointed by him shall audit the 
                                              accounts of the Fund and Balance 
                                              Sheet and the statement of 
                                              investments shall bear a 
                                              certificate of audit before the 
                                              submission of the annual report to 
                                              National Redemption Council as 
                                              aforesaid.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 42&#8212;Computations.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              All computations under these 
                                              Regulations for the purposes of 
                                              contributions to be&nbsp; recovered 
                                              from workers' pay, interest 
                                              benefits or for any other purpose, 
                                              shall be made correct to the 
                                              nearest pesewa; fractions of a 
                                              pesewa less than half shall be 
                                              ignored and half pesewa or more 
                                              shall be treated as a pesewa.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              PART V&#8212;FORMS</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 43&#8212;Signature and Thumb 
                                              Imprint on Document.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (1) Any document used in 
                                              connection with the Fund, which&nbsp; 
                                              requires a signature of the member 
                                              of the Fund may be signed with his 
                                              written signature but shall in any 
                                              case be authenticated by a clear 
                                              impression of his right thumb.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The thumb impression and the 
                                              signature, if any, shall in the 
                                              case of the worker's part of Form 
                                              SS 1 specified in the Schedule to 
                                              these Regulations be, witnessed 
                                              and counter- signed by the 
                                              employer or by an authorised 
                                              representative of the employer or 
                                              by an authorised representative of 
                                              the Chief Administrator:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Provided that&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) where, for any reason, it is 
                                              not possible to furnish the right 
                                              thumb impression of the member, he 
                                              may furnish a clear impression of 
                                              his left thumb print; and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) where, for any reason it is 
                                              not possible for the member to 
                                              furnish any thumb print the Chief 
                                              Administrator may accept such 
                                              other mark of identification as he 
                                              thinks fit.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 44&#8212;Change of 
                                              Nomination.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) A member who wishes to make 
                                              any change among the persons 
                                              previously nominated by him to 
                                              receive the benefits in the event 
                                              of his death or any change in the 
                                              extent of their shares must 
                                              complete Form SS 1&#8212;specified in 
                                              the Schedule to these Regulations.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The employer shall&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) afford the member every 
                                              facility for the purposes of 
                                              sub-regulation (1) of this 
                                              regulation;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (b) forward the completed form to 
                                              the Chief Administrator; and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) obtain and hand over to the 
                                              member the Chief Administrator's 
                                              acknowledgement of the form.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 45&#8212;Duplicate 
                                              Certificate of Membership.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) The Chief Administrator may, 
                                              in the event of loss of the 
                                              original Certificate of Membership 
                                              of a member and after conducting 
                                              any investigations as he thinks 
                                              necessary into its loss, issue a 
                                              Duplicate Certificate of 
                                              Membership to the member on 
                                              payment of a fee of thirty pesewas.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The duplicate certificate 
                                              shall be endorsed with the word 
                                              &quot;Duplicate&quot;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 46&#8212;Worker to Furnish 
                                              Information to Employer.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Every worker shall furnish to his 
                                              employer all information and 
                                              produce any documents necessary 
                                              for the completion of returns 
                                              prescribed by these Regulations 
                                              and required to be made by his 
                                              employer.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 47&#8212;Incomplete or 
                                              Inaccurate Document.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) If in the opinion of the Chief 
                                              Administrator any document 
                                              required to be completed under 
                                              these Regulations is incomplete, 
                                              inaccurate or is not clear to 
                                              identify the person concerned, he 
                                              may return the document to the 
                                              sender.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (2) The sender shall comply with 
                                              all lawful directions given to him 
                                              by the Chief Administrator and 
                                              shall within one week of the 
                                              receipt by him of the document 
                                              complete and forward to the Chief 
                                              Administrator a fresh document in 
                                              place of the original or return 
                                              the original document corrected 
                                              and authenticated as may be 
                                              required by the Chief 
                                              Administrator.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 48&#8212;Variation of Forms.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (1) Any form or document used in 
                                              connection with the Fund shall not 
                                              be deemed invalid by reason only 
                                              of the inclusion therein of 
                                              additional matter or of any 
                                              variation in its wording.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) Any form prescribed by these 
                                              Regulations may be altered or 
                                              amended to suit any particular 
                                              case and shall be valid for all 
                                              purposes.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">

                                              Regulation 49&#8212;Forms in Schedule 
                                              not Referred to in Regulations.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Any form set out in the Schedule 
                                              to these Regulations but not 
                                              specifically referred to elsewhere 
                                              in these Regulations may where 
                                              necessary be used for the purposes 
                                              for which the form is designed.
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">

                                              Regulation 50&#8212;Forms Obtainable 
                                              from the Chief Administrator.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) Forms prescribed under these 
                                              Regulations may be obtained free 
                                              of charge from the Chief 
                                              Administrator or any other 
                                              officers as may be notified for 
                                              the purpose.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The delay in receipt of any 
                                              prescribed form from the Chief 
                                              Administrator shall not absolve 
                                              the employer from his 
                                              responsibility for making any 
                                              payment to the Fund on the due 
                                              dates and any failure to make any 
                                              such payment shall be deemed a 
                                              contravention of these 
                                              Regulations.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              PART VI&#8212;GENERAL</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 51&#8212;Social Security 
                                              Clearance Certificate.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) No person, body of persons, or 
                                              authority, shall register, license 
                                              or grant a permit or authorisation 
                                              to an employer, unless such 
                                              employer produces a valid and 
                                              relevant Social Security Clearance 
                                              Certificate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) No licence or authorisation 
                                              shall be issued to any employer to 
                                              export, import, or to clear goods 
                                              intended for sale from any port or 
                                              factory in Ghana, unless the 
                                              employer produces to the 
                                              Comptroller of Customs and Excise 
                                              or the licensing authority a valid 
                                              and relevant Social Security 
                                              Clearance Certificate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (3) No insurance company or 
                                              corporation shall pay any money in 
                                              respect of any claim made under 
                                              any policy issued by that company 
                                              or corporation unless the 
                                              employer, to whom the money is 
                                              payable under the policy, produces 
                                              to the insurance company or 
                                              corporation a valid and relevant 
                                              Social Security Clearance 
                                              Certificate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (4) An alien employer may not be 
                                              permitted to leave Ghana &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              unless he produces to the 
                                              appropriate immigration 
                                              authorities a valid Social 
                                              Security Clearance Certificate 
                                              issued in respect of his 
                                              establishment.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (5) Where any authority or person 
                                              is empowered by any enactment to 
                                              grant any permit or authorisation 
                                              in respect of the construction of 
                                              any building or the execution of 
                                              any work on any building, that 
                                              authority or person shall not 
                                              grant any such permit or 
                                              authorisation unless the employer 
                                              applying for such permit or 
                                              authorisation produces to such 
                                              authority or person a valid and 
                                              relevant Social Security Clearance 
                                              Certificate.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (6) Where any authority or person 
                                              is empowered by any enactment to 
                                              effect the registration of any 
                                              document conferring title to any 
                                              land, that authority or person 
                                              shall not effect the registration 
                                              of such documents to an employer 
                                              unless there is produced to such 
                                              authority or person a valid and 
                                              relevant Social Security Clearance 
                                              Certificate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (7) The State Housing Corporation 
                                              shall not sell or grant any lease 
                                              in respect of any building to an 
                                              employer unless such employer, 
                                              produces to the said corporation a 
                                              valid and relevant Social Security 
                                              Clearance Certificate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (8) Unless the Chief Administrator 
                                              otherwise directs, no authority or 
                                              other person responsible for the 
                                              award of any contract for the 
                                              execution of any works or for the 
                                              performance of any service, the 
                                              consideration for which is not 
                                              less than three thousand cedis, 
                                              shall award or pay for any such 
                                              contract to any employer unless 
                                              the employer to whom the contract 
                                              is to be awarded or payment is to 
                                              be made produces to such authority 
                                              or person a valid and relevant 
                                              Social Security Clearance 
                                              Certificate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (9) Unless the Chief Administrator 
                                              otherwise directs, no authorised 
                                              dealer within the meaning of the 
                                              Exchange Control Act, 1961 (Act 
                                              71) shall sell any external 
                                              currency within the meaning of 
                                              that Act not being less than three 
                                              hundred cedis in value, to any 
                                              employer unless that employer 
                                              produces to such authorised dealer 
                                              a valid and relevant Social 
                                              Security Clearance Certificate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (10) No tax Clearance Certificate 
                                              shall be issued to an employer 
                                              unless such employer produces a 
                                              valid and relevant Social Security 
                                              Clearance Certificate to the 
                                              Commissioner of Income Tax.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (11) No local authority, statutory 
                                              corporation or board, educational 
                                              Institution, or body of similar 
                                              description, shall obtain or be 
                                              given Government subvention, 
                                              subsidy or grant without first 
                                              producing a valid and relevant 
                                              Social Security Clearance 
                                              Certificate to the appropriate 
                                              authority or person.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (12) For the purposes of this 
                                              regulation&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              &#8220;a Social Security Clearance 
                                              Certificate&#8221; means a Certificate 
                                              issued by the Chief Administrator, 
                                              certifying that all social 
                                              security contributions due from an 
                                              employer, have been paid and that 
                                              all relevant information has been 
                                              supplied or that such employer has 
                                              made arrangements satisfactory to 
                                              the Chief Administrator, for the 
                                              payment of contributions and for 
                                              the supply of all relevant 
                                              information.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (13) Such certificate shall be 
                                              valid for a period of six months, 
                                              but may be revoked by the Chief 
                                              Administrator, if the employer 
                                              fails to fulfil his obligations 
                                              under the Decree or these 
                                              Regulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">

                                              Regulation 52&#8212;Competency to 
                                              Nominate.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">A 
                                              worker who has reached the age of 
                                              fifteen years shall be competent 
                                              to nominate beneficiaries to whom 
                                              the accumulations standing to his 
                                              credit, should be paid in the 
                                              event of his death before 
                                              superannuation.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 53&#8212;Date of Birth may be 
                                              Estimated where Necessary.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) Where a worker is unable to 
                                              state his date of birth, the 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; employer shall estimate 
                                              his age from appearance and any 
                                              other known facts and shall record 
                                              a date of birth on the appropriate 
                                              form.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) Such date of birth shall, for 
                                              purposes of these Regulations, be 
                                              treated as the actual date of 
                                              birth unless it is amended by the 
                                              Chief Administrator.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 54&#8212;Returns Required in 
                                              Respect of Existing Schemes.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) The employer of an 
                                              establishment having its own 
                                              private scheme of pension, 
                                              gratuity or provident fund, shall 
                                              send to the Chief Administrator 
                                              returns concerning his private 
                                              scheme as returns required in 
                                              respect of existing schemes 
                                              described as follows: &#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">

                                              <span style="font-family: Arial">
                                              (a) the first return shall be 
                                              submitted not later than three 
                                              months after the date of 
                                              commencement of these Regulations 
                                              or in the case of a scheme started 
                                              after the commencement of these 
                                              Regulations, not later than three 
                                              months after the starting of the 
                                              scheme and shall include the 
                                              following: &#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">(i) 
                                              A list of the members of the Board 
                                              of trustees showing 
                                              representatives of the workers and 
                                              representatives of the employer, 
                                              and of the Government, if any,</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (ii) A copy of the up-to-date 
                                              constitution and rules,</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (iii) A balance sheet as at the 
                                              date immediately preceding the 
                                              date of commencement of these 
                                              Regulations, clearly showing 
                                              assets and liabilities of the 
                                              scheme, and a detailed statement 
                                              of investments, loans granted and 
                                              other securities, reserves, and 
                                              forfeiture or lapsed accounts;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) thereafter, statements 
                                              relating to quarters of the year 
                                              ending March, June, September and 
                                              December as the case may be, shall 
                                              be submitted quarterly within 
                                              fifteen days from the end of the 
                                              quarter and shall cover 
                                              contributions received, benefits 
                                              paid out and investments made 
                                              during the preceding three months;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (c) a copy of the annual balance 
                                              sheet showing the assets and 
                                              liabilities of the existing scheme 
                                              on the thirty-first day of 
                                              December each year shall be sent 
                                              to the Chief Administrator duly 
                                              signed by auditors by the 
                                              thirty-first of the following 
                                              month of March.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) Where immediately before the 
                                              commencement of these Regulations, 
                                              Regulation 57 of the Social 
                                              Security Fund Regulations, 1965 (L.I. 
                                              470) applied to the employer, and 
                                              he complied with that Regulation, 
                                              then only paragraphs (b) and (c) 
                                              of Regulation 54 (1) of these 
                                              Regulations shall apply to him.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 55&#8212;Interpretation.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              In these Regulations, unless the 
                                              context otherwise requires&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &quot;Board&quot; means the Board of 
                                              Directors of the Trust set up 
                                              under the Decree;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &quot;existing scheme&quot; means any scheme 
                                              of pension, provident fund or 
                                              gratuity or a combination of any 
                                              of these schemes existing on the 
                                              lst day of July, 1972 (the date on 
                                              which the Decree came into force) 
                                              or any scheme started after that 
                                              date, but shall not include any 
                                              scheme applicable to exempt 
                                              persons mentioned under the 
                                              Schedule to the Decree;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8220;Fund&#8221; means the Social Security 
                                              Fund;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &#8220;Trust&#8221; means the Social Security 
                                              and National Insurance Trust.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 56&#8212;These Regulations 
                                              are to be Read as One with L.I. 
                                              777.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              These Regulations shall be read as 
                                              one with the Social Security 
                                              (Unemployment Benefit) 
                                              Regulations, 1972 (L.I. 777).</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 57&#8212;Revocation.</span></b></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Social Security Fund 
                                              Regulations, 1965 (L.I. 470) are 
                                              hereby revoked.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <i>
                                              <span style="font-family: Arial">
                                              SCHEDULE</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              FORM SS 1</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Surname&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; First Name&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Initials &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Social 
                                              Security Number&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              WORKER REGISTRATION CARD</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              EMPLOYER INDICATE</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Employer Reg. No.&nbsp;&nbsp; Worker&#8217;s 
                                              Serial No.&nbsp; Normal Monthly Pay&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              PLEASE PRINT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              WORKER&#8217;S 
                                              NAME&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Surname&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; First&nbsp;&nbsp;&nbsp; 
                                              Second&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Init.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              PREVIOUS 
                                              NAME&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Surname&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; First&nbsp;&nbsp;&nbsp; 
                                              Second&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Init.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              PERMANENT ADDRESS &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;(M)
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SEX </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (F)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Single&nbsp;&nbsp;&nbsp; 
                                              (S)&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Married&nbsp; (M)</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Widowed (W)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Ghanaian (G) </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Non-Ghanaian(N)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Daily Rated (D)</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Monthly Rated (M)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Birth Date</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Day..Mth..Year..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              District &#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp; Home Town &#8230;&#8230;&#8230;&nbsp; 
                                              Region &#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp; Religion &#8230;&#8230;&#8230;&#8230;.&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              NAME OF 
                                              FATHER&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Surname&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; First Name&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Initials Title&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              NAME OF 
                                              MOTHER&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Surname&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; First Name&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Initials Title&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              CERTIFY 
                                              THAT:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) I have never been registered 
                                              as a member of this FUND, and&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) the facts stated above are 
                                              true and accurate.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Date&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Signature of Worker</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp; INSTRUCTIONS FOR COMPLETING 
                                              THIS CARD&nbsp;&nbsp;&nbsp;&nbsp; RIGHT THUMB 
                                              PRINT&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              If Right Thumb is missing check 
                                              Finger Imprinted:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; One card only must be 
                                              completed and signed by each 
                                              worker.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; All questions must be 
                                              answered.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Please print all 
                                              answers in ink or typewrite.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              4. Do not soil or otherwise 
                                              mutilate this card in any way.&nbsp;&nbsp;&nbsp; 
                                              Remember this card will serve as a 
                                              permanent record for&nbsp; the purposes 
                                              of the Worker&#8217;s membership of the 
                                              Fund.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              5. The employer must supervise and 
                                              certify the completion of this 
                                              Card.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; LEFT&nbsp; 
                                              RIGHT </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              T&#8217;MB&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; X&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              index&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              3&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              4&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              5&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; FORM SS-1</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA SOCIAL SECURITY 
                                              DECREE, 1972 CERTIFICATE OF 
                                              MEMBERSHIP</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Name &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              IMPORTANT.&#8212;Keep this Card&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              safely and show it to New 
                                              Employer.&nbsp;&nbsp;&nbsp;&nbsp; If you do not do so, 
                                              your contributions may go to 
                                              someone else.&nbsp; This Card will be 
                                              required when you make a claim for 
                                              benefits under the Act.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              DUPLICATE</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS-1B&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; REPUBLIC OF 
                                              GHANA SOCIAL SECURITY DECREE, 1972 
                                              CERTIFICATE OF MEMBERSHIP</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Name &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature ..&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              IMPORTANT.&#8212;Keep this Card&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              safely and show it to New 
                                              Employer.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; If you do not do 
                                              so, your contributions&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; may 
                                              go to someone else.&nbsp; This Card 
                                              will be required when you make a 
                                              claim for benefits under the Act.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ORIGINAL</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS-1A&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp; 
                                              RIGHT&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              THUMB PRINT&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS-1</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              BENEFICIARY NOMINATION FORM</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              HEREBY nominate the person(s) 
                                              mentioned below to receive the 
                                              amount standing to my credit in 
                                              the Fund, in the event of my 
                                              death, and direct that the said 
                                              amount shall be distributed among 
                                              the said person(s) in the 
                                              percentages indicated below.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Name and Permanent Address of 
                                              Nominee&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Relationship to 
                                              Worker&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Home town and Region&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Age of 
                                              Nominee&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Percentage 
                                              of&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Benefit </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              RIGHT THUMBPRINT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;.&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Date&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Signature</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">I 
                                              CERTIFY THAT:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1)&nbsp; Completion of both sides of 
                                              this form was properly supervised.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) The, thumb prints and 
                                              signatures on the two membership 
                                              certificates, on the reverse side 
                                              of this Card and entered above, I 
                                              witness as being those of the 
                                              worker named on this Card who is 
                                              employed by me/us.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) I have given the original 
                                              Membership Certificate to this 
                                              worker.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              .....&#8230;&#8230;&#8230;&#8230;..&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Name of 
                                              Employer&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Signature of Employer or his 
                                              Authorised Agent</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;..&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. Address of 
                                              Employer&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Title</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              TO ENSURE FREEDOM FROM WANT IN OLD 
                                              AGE AND FOR FAMILY</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              1. Continue working till 
                                              retirement. Membership of the Fund 
                                              continues under new employer also.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              2. Nominate one or more Family 
                                              member(s) to receive benefits, 
                                              should you unfortunately die 
                                              before retirement; save them 
                                              expense, trouble and destitution.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              3. Keep Annual Statements of your 
                                              Account carefully as record of 
                                              your rapidly mounting 
                                              accumulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              4. Refer inquiries to NPF 
                                              Inspector of your area, or to the 
                                              Chief Administrator of the Fund, 
                                              P.O. Box M.149, Accra.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FACE THE FUTURE WITH 
                                              CONFIDENCE.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; TO ENSURE 
                                              FREEDOM FROM WANT IN OLD AGE AND 
                                              FOR FAMILY</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              1. Continue working till 
                                              retirement. Membership of the Fund 
                                              continues under new employer also.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              2. Nominate one or more Family 
                                              member(s) to receive benefits, 
                                              should you unfortunately die 
                                              before retirement; save them 
                                              expense, trouble and destitution.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              3. Keep Annual Statements of your 
                                              Account carefully as record of 
                                              your rapidly mounting 
                                              accumulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              4. Refer inquiries to NPF 
                                              Inspector of your area, or to the 
                                              Chief Administrator of the Fund, 
                                              P.O. Box M.149, Accra.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              FACE THE FUTURE WITH 
                                              CONFIDENCE.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ___________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 2</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. SOCIAL SECURITY 
                                              NUMBER&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. NO. OF WORKERS&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              See 6 (1) below</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              EMPLOYER REGISTRATION CARD</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              1. NAME OF EMPLOYER 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              2. ADDRESS OF 
                                              EMPLOYER&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Street&nbsp; P.O. Box No.&nbsp; 
                                              Town&nbsp;&nbsp; Office Tel.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              3. NAME OF HEAD OFFICE 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              4. ADDRESS OF HEAD 
                                              OFFICE&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Street&nbsp; P.O. Box No.&nbsp; 
                                              Town&nbsp;&nbsp; Office Tel.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              5. DESCRIPTION OF ECONOMIC 
                                              ACTIVITY ENGAGED IN 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.............&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ....................................................................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              6. I HEREBY CERTIFY THAT&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) As of the 
                                              .........................day 
                                              of.........................1972, I 
                                              have&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; workers on my payroll 
                                              who are subject to be covered 
                                              under the provisions of the Social 
                                              Security Decree, 1972;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (2) I am returning 
                                              herewith&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Workers Registration Cards duly 
                                              completed;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) I undertake to submit the 
                                              remaining 
                                              .........................Workers 
                                              Registration Cards duly completed 
                                              as soon as possible;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (4) I am returning herewith 
                                              ........................................&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              blank Workers Registration Cards 
                                              which is/are in excess of my 
                                              requirements.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Date&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &#8230;&#8230;........................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature of Employer or his 
                                              authorised Agent</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              _____________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 3</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              To the Chief 
                                              Administrator,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Social Security 
                                              Fund,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;P.O. 
                                              Box 
                                              M.149,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Accra.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ADVICE OF PAYMENT OF CONTRIBUTIONS</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              EMPLOYER REGISTRATION No. 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              NAME&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ADDRESS 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              IN RESPECT OF CONTRIBUTIONS FOR 
                                              THE&#8230;.&#8230;.................&#8230;&#8230; MONTH(S) 
                                              ENDED &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..19&#8230;&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ¢&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              p&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              THIS AMOUNT INCLUDES CHANGES MADE 
                                              ON THE LIST OF CONTRIBUTORS 
                                              ATTACHED HERETO&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              AMOUNT DUE FOR PERIOD </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ARREARS B/FORWARD&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              TOTAL PAID&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *CHEQUE No. ) &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;DATE 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              M.O./P.O.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; )</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *BANK AND BRANCH PAID TO 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *BANK BRANCH No. &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &#8230;&#8230;.......&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; Employer's 
                                              Signature</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Date&#8230;&#8230;.......................................&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              N.B.&#8212;This form should be forwarded 
                                              to the Chief Administrator, as 
                                              soon as possible, attached to:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              either (i) the duplicate copy of 
                                              the paying-in-slip, and list of 
                                              contributors, or</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (ii) the duplicate copy of the 
                                              official receipt and the list of 
                                              contributors, or</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;(iii) the remittance.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FOR USE IN OFFICE OF FUND</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Certified that the above total 
                                              amount has been verified on the 
                                              *Paying-in-Slip/* Official receipt 
                                              No&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; Initials of Officer</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Date&#8230;...................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *Delete if inapplicable</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 4</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              SOCIAL SECURITY DECREE, 1972</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              THE CHIEF 
                                              ADMINISTRATOR,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              SOCIAL SECURITY 
                                              FUND,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;P.O. BOX 
                                              M.149,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ACCRA.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              APPLICATION FOR PAYMENT OF 
                                              SUPERANNUATION OR INVALIDITY 
                                              BENEFIT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              IMPORTANT: N.B.&#8212;Any person who 
                                              makes a false statement or 
                                              representation or produces or 
                                              furnishes or causes to be produced 
                                              or furnished any information which 
                                              he knows to be false in a material 
                                              particular is guilty of an offence 
                                              under the SOCIAL SECURITY DECREE, 
                                              1972.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Member's A/c No.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              as on Certificate of&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Membership</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;{Full Name</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              {Surname 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; { 
                                              (Block Letters)</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Particulars of &nbsp;&nbsp;&nbsp;&nbsp; {Other Names 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; member&nbsp;&nbsp;&nbsp; 
                                              {&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Block Letters)</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              {Son&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;{_______ 
                                              of&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              { 
                                              Daughter&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;{ 
                                              Date of 
                                              Birth&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.....&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              wish to claim the whole amount due 
                                              to the above-described account in 
                                              the SOCIAL SECURITY FUND.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              The condition under which I claim 
                                              payment of the benefit is marked X 
                                              below. My Certificate of 
                                              membership is forwarded herewith.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; I have attained the 
                                              age of 55/50 years and retired 
                                              from employment as a worker 
                                              on&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&nbsp;&nbsp; </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; I am a permanent 
                                              invalid unable to work and attach 
                                              a medical certificate to that 
                                              effect &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Payment Instructions</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Full Postal Address to which the 
                                              cheque for payment should be 
                                              sent:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (IN BLOCK LETTERS) 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature of person making 
                                              application and Date</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Right thumb impression of person 
                                              making application</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature of Witness 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...........</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Address 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;................................................................ 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.....................&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              CERTIFIED that the above-named 
                                              member has ceased to be employed 
                                              by me due to 
                                              superannuation/permanent 
                                              invalidity/with effect from 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.........</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Signature 
                                              of Employer</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Registration No. of 
                                              Establishment&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Date&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FOR USE IN HEAD OFFICE OF FUND</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Benefit Authorised:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Amount of last 
                                              balance&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp; ¢</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *Age&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Add: (a) 
                                              Interest&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; ¢</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (b) 
                                              Contributions received since&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp; ¢ ________________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *Invalidity</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Less: Subsidiary benefit paid 
                                              since&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; ¢ 
                                              __________________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Net amount 
                                              payable&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; ¢</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ________________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Cheque No&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. for 
                                              ¢&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..issued on 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.......&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;Initials</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Payment of Benefit )&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&nbsp;&nbsp; 
                                              Date&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;........ listed 
                                              for posting&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              )&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Initials</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Member's record 
                                              extracted&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Initials</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *Delete what does not apply</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 5</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              THE CHIEF 
                                              ADMINISTRATOR,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              SOCIAL SECURITY 
                                              FUND,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              P.O. BOX M.149,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;ACCRA.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              APPLICATION FOR PAYMENT OF 
                                              SURVIVOR'S BENEFIT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Important.&#8212;The deceased's 
                                              membership card and a copy of the 
                                              certificate of death should 
                                              accompany this form unless they 
                                              have been, or are being, sent in 
                                              by some other claimant.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Employer's Reg. No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Member's 
                                              Acct. No.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Fund Account particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;{Full Name 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              {Son</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Particulars of member {_______ of 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              {Daughter</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              {Date of birth 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;....</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              claim payment of the whole or part 
                                              of the amount due to the 
                                              above-described account in the 
                                              Social Security Fund on the 
                                              following grounds:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              1. That the member of the Fund 
                                              died testate/intestate*</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *2. That the deceased was at the 
                                              time of his death subject to 
                                              customary law and I am (or I the 
                                              claimant and 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#8230;&#8230;&#8230;&#8230;..are)* 
                                              solely entitled to the benefit.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *3. That the deceased was at the 
                                              time of his death subject to 
                                              Moslem law and I am (or I the 
                                              claimant and 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.are)*&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              solely entitled to the benefit.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *4. That I am the executor, 
                                              administrator, or next of kin, or 
                                              guardian*.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *5. That application for 
                                              probate/Administration* of the 
                                              deceased's estate has/has not* 
                                              been made.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *6. That to the best of my 
                                              knowledge and belief the only 
                                              other relatives of the deceased 
                                              member of the Fund who may claim 
                                              to be entitled are (here set out 
                                              names of widow, widower, child, 
                                              father, mother, brothers and 
                                              sisters as the case may be if 
                                              known to the claimant) 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">I 
                                              declare that where the foregoing 
                                              facts are within my own personal 
                                              knowledge they are true and where 
                                              they are not within my personal 
                                              knowledge I verily believe them to 
                                              be true.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Station&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Date 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ....&#8230;&#8230;.&#8230;&#8230;.........................................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature and impression of right 
                                              thumb of claimant</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Declared at &#8230;&#8230;&#8230;............this 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..day of&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.19&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Witness:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Occupation &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Address &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;......................&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature of Witness</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              _____________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              *Delete or amend as necessary.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              N.B.&#8212;The witness must be a 
                                              Magistrate; a Justice of the 
                                              Peace; and Officer in charge of a 
                                              Police District; a Labour Officer 
                                              or a civil servant, Local 
                                              Government or Native Authority 
                                              Officer not below the rank of a 
                                              clerical officer; a Registered 
                                              Medical Practitioner; an Advocate 
                                              or Solicitor; or Consul, or 
                                              official of no less status outside 
                                              Ghana.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FOR USE IN HEAD OFFICE OF FUND
                                              </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Survivors' Benefit Authorised:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Amount of last balance&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; ¢</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Add: (a) Interest&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; ¢</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (b) Contributions 
                                              received 
                                              since&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; 
                                              ¢ ________________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Less: Subsidiary benefit paid 
                                              since&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp; ¢ ________________________</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Net amount payable&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; 
                                              ¢________________________</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Cheque No&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. for 
                                              ¢&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..issued on &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Initials 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Payment of Benefit listed for 
                                              posting.....&#8230;&#8230;&#8230;&#8230;&#8230;Date&#8230;&#8230;&#8230;&#8230;&#8230;.Initials&#8230;&#8230;....&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Contributor&#8217;s record extracted 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;......&#8230;Initials&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              _____________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 6</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              THE CHIEF 
                                              ADMINISTRATOR,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              SOCIAL SECURITY 
                                              FUND,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              P.O. BOX M.149,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;ACCRA.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              APPLICATION FOR EMIGRATION BENEFIT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              N.B.&#8212;The Certificate of membership 
                                              should accompany this form.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Employer's 
                                              Reg. No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Member's Acct. No.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Fund Account particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;{Full Name Surname 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;{&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Block Letters)</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; {Other Names 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              {&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Block Letters)</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              {Son</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              {_______ 
                                              of&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; { 
                                              Daughter</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; { Date 
                                              of 
                                              Birth&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              wish to claim the whole amount due 
                                              to the above-described account in 
                                              the SOCIAL SECURITY FUND.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">* 
                                              I left/am leaving Ghana 
                                              on&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;with no 
                                              intention of returning. My future 
                                              address will be 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;......... 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;......</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Payment instructions.&#8212;Full postal 
                                              address to which the Warrant for 
                                              payment should be 
                                              sent:&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Block Letters)</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Post Office/Sub-Treasury at which 
                                              payment is 
                                              desired&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#8230;&#8230;&#8230;&#8230;...</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.......*Post 
                                              Office&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Sub-Treasury</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Delete what does not apply.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              N.B.&#8212;Any person who makes a false 
                                              statement or representation or who 
                                              produces or furnishes or causes to 
                                              be produced or furnished any 
                                              information which he knows to be 
                                              false in a material particular is 
                                              guilty of an offence under the 
                                              Decree.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Witness&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#8230;&#8230;&#8230;&#8230;&#8230;......&#8230; 
                                              Signature and right thumb 
                                              impression</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Address&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp; Date 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              FOR USE IN HEAD OFFICE OF FUND</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Benefit Authorised:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Emigration Grant</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Amount of last 
                                              balance ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp; ¢&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; :&nbsp;&nbsp;&nbsp; p</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Add (a) 
                                              Interest&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ¢&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; :&nbsp;&nbsp;&nbsp; p</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;(b) Contribution received 
                                              since&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp; ¢&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              :&nbsp;&nbsp;&nbsp; p</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              _______________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Less: Subsidiary 
                                              benefit paid since&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ¢ _______________________</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Net amount 
                                              payable&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ¢_______________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Cheque No&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. for 
                                              ¢&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..issued on &#8230;.....&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;Initials</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Payment of Benefit listed for 
                                              posting 
                                              )&#8230;&#8230;&#8230;&#8230;&#8230;.........&#8230;&#8230;&#8230;&#8230;Date&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..Initials</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Contributor&#8217;s record 
                                              extracted&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.Initials</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.Initials</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 7</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              THE CHIEF 
                                              ADMINISTRATOR,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;SOCIAL 
                                              SECURITY 
                                              FUND,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              P.O. BOX 
                                              M.149,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;ACCRA.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              APPLICATION FOR SICKNESS BENEFIT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              IMPORTANT.&#8212;The medical certificate 
                                              overleaf should be completed by a 
                                              registered medical practitioner.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Member's Account No.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Fund account particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              {Full Name Surname 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;......... 
                                              {&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Block Letters) </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; {Other Names 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;......&#8230;..
                                              </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Block 
                                              Letters)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              {Son*</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; {_______ 
                                              of&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;......</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; { 
                                              Daughter*</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; { Date of 
                                              Birth 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...........</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              claim sickness benefit for the 
                                              period from 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;to..&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;during 
                                              which period I was ill and 
                                              incapable of work.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *I was not in receipt of any 
                                              payment from my employer for that 
                                              period.&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Payment instructions.&#8212;Full postal 
                                              address to which the payment of 
                                              benefit should be addressed 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#8230;&#8230;&#8230;&#8230;&#8230;.&nbsp; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..............&#8230;&#8230;&#8230;&#8230;&#8230;(in 
                                              Block Letters) 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Witness&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Signature and right 
                                              thumb impression of 
                                              member&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Address 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              *Strike out what does not apply.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              EMPLOYER'S CERTIFICATE</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Certified that the above 
                                              statements are correct. The 
                                              claimant was not in receipt of any 
                                              emoluments during such sickness.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Signature 
                                              of Employer</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Registration No 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              MEDICAL CERTIFICATE</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Certified that the above-named has 
                                              been medically examined by me 
                                              today. He has been ill/appears to 
                                              have been ill for not less than 
                                              the past three months and is 
                                              likely to remain absent from work 
                                              due to illness for the next 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;months/weeks/days.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature of Doctor 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..........&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Full 
                                              name&#8230;&#8230;&#8230;&#8230;.&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;............. 
                                              Address &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;....... 
                                              Medical qualification 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...........</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Date&#8230;&#8230;&#8230;&#8230;..............................Registered 
                                              No&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..........</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              N.B.&#8212;Any person who makes a false 
                                              statement or representation or who 
                                              produces or furnishes or causes to 
                                              be produced or furnished any 
                                              information which he knows to be 
                                              false in a material particular is 
                                              guilty of an offence under the 
                                              Decree.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              FOR USE IN HEAD OFFICE OF SOCIAL 
                                              SECURITY FUND</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Benefit 
                                              Authorised:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Cumulative 
                                              amount of benefit already</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Sickness Benefit&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              received&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp; ¢</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Add: Benefit now authorised&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp; ¢__________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Total&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ..&nbsp;&nbsp;&nbsp; ¢</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Balance in member's account&nbsp;&nbsp; 
                                              ..&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;..&nbsp;&nbsp;&nbsp;&nbsp; ¢</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              __________________</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Cheque Number&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. for 
                                              ¢&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...issued 
                                              on&#8230;&#8230;&#8230;.&#8230;............&#8230;&#8230;Initials</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Initials&#8230;&#8230;&#8230;&#8230;&#8230;........&#8230;&#8230;&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Payment of benefit listed for 
                                              posting ..&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; Date 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#8230;....... </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Initials&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.........</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 8</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              AUTHORITY TO RECEIVE THE AMOUNT OF 
                                              BENEFIT ON BEHALF OF MEMBER</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Important.&#8212;When completed this 
                                              form must be stamped as a power of 
                                              attorney under the Stamped Duties 
                                              Ordinance.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Employer&#8217;s Reg. No.&nbsp; Member&#8217;s A/C 
                                              No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FOR OFFICIAL USE ONLY</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Number of Cheque&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Date of Cheque&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Fund Account 
                                              Particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              TO WHOM IT MAY CONCERN</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              I, the undersigned, being the 
                                              person entitled to benefit or a 
                                              refund of contributions on the 
                                              above-described account, do hereby 
                                              authorise &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              whose signature and thumb 
                                              impression are hereunder affixed 
                                              to receive on my behalf the sum 
                                              due to me for which sum the 
                                              receipt of the above-named person 
                                              shall be a proper discharge.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              As witness my hand this 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;day of &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;19&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;......... 
                                              Signature and right thumb 
                                              impression of Claimant</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;*Signed in the presence of 
                                              ....&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...........</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Address&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...........&#8230;.&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Office or 
                                              Qualification&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;........................</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature and right thumb 
                                              impression of person authorised to 
                                              receive 
                                              payment&#8230;&#8230;&#8230;&#8230;.............&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              When the person giving the 
                                              authority cannot read and write 
                                              English, the following certificate 
                                              should also be signed:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              certify that this authority, 
                                              before being signed by the said 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..has been first 
                                              audibly, clearly and distinctly 
                                              read over to him in my presence 
                                              and hearing, when the said person 
                                              appeared perfectly to understand 
                                              the same and made his mark 
                                              thereto.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *Signature of Witness</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              _______________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              *This form must be signed in the 
                                              presence of a person of any of the 
                                              following classes:&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) A Magistrate</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) A Justice of the Peace</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (3) An Officer in charge of a 
                                              police district</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (4) A Civil Servant or Local 
                                              Government or Native Authority 
                                              Officer not below the rank of 
                                              Clerical Officer.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (5) A Registered Medical 
                                              Practitioner</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (6) An Advocate or Solicitor</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (7) A Consul or official of no 
                                              less status outside Ghana.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              CERTIFICATE OF APPOINTMENT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              PHOTOGRAPH&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Under the 
                                              provisions of subsection (1) of 
                                              section 10 of the SOCIAL SECURITY 
                                              DECREE, 1972</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&nbsp;&nbsp; </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; margin-left: 72.0pt">
                                              <i>

                                              <span style="font-family: Arial">
                                              (Name in full)</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;........&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; is 
                                              hereby appointed and authorised to 
                                              exercise the&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Holder&#8217;s 
                                              Signature&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              functions of an Inspector under 
                                              the aforesaid Decree</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Chief 
                                              Administrator,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Social Security and National 
                                              Insurance Trust </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ACCRA.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Date&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY AND NATIONAL 
                                              INSURANCE TRUST GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              IDENTITY CARD</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FORM SS 9</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ______________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY DECREE, 1972</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              TO THE CHIEF 
                                              ADMINISTRATOR,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              FORM SS 
                                              10&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              SOCIAL SECURITY 
                                              FUND,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;P.O. 
                                              BOX 
                                              M.149,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              ACCRA.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              ACKNOWLEDGEMENT OF RECEIPT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              RECEIVED with thanks the sum 
                                              of&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;Cedis &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;.... pesewas (¢&#8230;&#8230;&#8230;) being the 
                                              amount of &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..in 
                                              respect.............of &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;RIGHT 
                                              HAND</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              EXEMPT&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              {&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              FROM&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              {&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&nbsp;&nbsp; STAMP&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Name 
                                              of Member/{Signature of 
                                              Member/Payee 
                                              &nbsp;&nbsp;DUTY&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Payee&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; {&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              THUMBPRINT OF</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Member's Registration No. 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              __________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              FOR USE IN CHIEF ADMINISTRATOR'S 
                                              OFFICE ONLY</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              The above amount was authorised in 
                                              papers No&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              and has been listed for posting.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; Signature of Official</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              _____________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 180.0pt">
                                              <span style="font-family: Arial">
                                              COLONEL I. K. ACHEAMPONG</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 180.0pt">
                                              <i>
                                              <span style="font-family: Arial">
                                              Commissioner Responsible for 
                                              Finance</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Date of Gazette Notification: 27th 
                                              April, 1973.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>