HarpRehabs

Membership Form

MEMBERSHIP REGISTRATION FORM

The Volta Lake Cooperative Credit Union offers financial services to registered members in the form of accepting deposits, granting loans, and financial counselling.

Personal Information

Full Name *

Nationality *

Date of Birth *

Gender *

Marital Status *

Contact Information

Postal Address *

Residential Address/Digital Address *

Phone Number *

Email *

Hometown & Region

Identification

Type of ID *

ID Card Number *

Date ID Card Issued *

Upload ID Card *

📁 Click to upload ID Card (Max 10MB)

Employment Information

Occupation *

Name of Employer

Staff Number

Employer's Digital Address

Employer's Postal Address and Telephone

Emergency Contact & Beneficiaries

Contact Person & Contact

Beneficiaries *

State the name, address, telephone of beneficiaries and percentage assigned.
Example: (1) John Doe / Box 45 Accra / 0243859151 / 50%, (2) Jane Smith / Box 4 Tema / 0208771043 / 50%

Document Uploads

Passport Photo *

📷 Upload Passport Photo (Max 100MB)

Signature *

✍️ Upload Signature (You can sign on paper and capture) (Max 100MB)

* I hereby apply for membership of the Volta Lake Cooperative Credit Union and agree to be bound by the bye-laws of the union. I understand that to have a successful society, members must regularly save and receive loans for good purposes only and make regular repayments of all loans taken.