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Personal Details:

Member Name:

Axis Account Number:

SSNIT #:

Email:

Mobile #:

ID Type -- Select -- Driver's License National ID New Voter Identification Old Voter Identification Passport Social Security Student's Identification Card

ID #:

Withdrawal Details:

Reason for withdrawing --Select Reason-- To meet urgent need Retirement Emigration from Ghana Medical

Account Member (Retirement) Account AVC (Savings) Account

Member (Retirement) Account

Withdrawal Option --Select Option-- Partial Withdrawal Full Withdrawal

Amount

AVC (Savings) Account

Withdrawal Option --Select Option-- Partial Withdrawal Full Withdrawal

Amount

Continue with Debit Order: Yes No Other

Banking Details:

Bank Select ... ABSA BANK GHANA ACCESS BANK AGRICULTURAL DEVELOPMENT BANK ARB APEX RURAL BANK/RURAL & COMMUNITY BANKS BANK OF AFRICA (GH) LTD BANK OF BARODA (GH) LTD BANK OF GHANA BEIGE BANK CAL BANK CAPITAL BANK CONSOLIDATED BANK GHANA ECOBANK ENERGY BANK FBN BANK FIDELITY BANK FIRST ATLANTIC BANK FIRST NATIONAL BANK GCB BANK GHANA HOME LOANS GN BANK GUARANTY TRUST BANK HERITAGE BANK NATIONAL INVESTMENT BANK OMNIBANK GHANA LIMITED PREMIUM BANK PRUDENTIAL BANK REPUBLIC BANK SAHEL-SAHARA BANK SOCIETE GENERALE SOVEREIGN BANK LTD STANBIC BANK STANDARD CHARTERED BANK THE ROYAL BANK UNIBANK UNITED BANK FOR AFRICA UNIVERSAL MERCHANT BANK UT BANK WOMEN'S WORLD BANKING GHANA ZENITH BANK

Bank Branch:

Account Name:

Account #:

Signature upload:

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I accept the indemnity detailed here

 

I, certify that to the best of my knowledge and belief, the statements made in this form are correct and complete. I agree that I should be charged the appropriate penalty if my account falls short of the prescribed holding period. Accordingly, I authorize Axis Pension Trust to charge 5% of the amount I withdraw from the Savings sub-Account, if my account is less than 3 years old or 3% if my account is more than 3 but less than 5 years old. For the Retirement sub-Account, I authorize Axis Pension Trust to charge 10% of the amount withdrawn if my account is less than 5 years old or 5% of the withdrawn amount if my account is more than 5 years old but less than 10 years. I authorize Axis Pension Trust to act on this instruction and pay my benefits to the bank account details given above.