GOCLUB REGISTRATION

GOCLUB REGISTRATION
Please provide your GOCARD Details
Full Name (Name on GOCARD)*

First NameLast Name
Mobile Tel. Number*
Please enter your mobile number used for GOCard RegistrationFormat: (000) 000-0000.
Card Number*
Enter 16-Digits on your Card
LIFE INSURANCE DETAILS

Free Life Insurance is one of the Benefits of joining the GOClub. Please provide the following details in case of any Insurance claim.
Is your beneficiary older than 18 years?*

YesNo
Beneficiary Name

First NameLast Name
Address (Postal)*

Example : P.O. Box 1234

Example AN- Accra North

CityRegion

Postal / Zip Code
Address (Residential)*

Street Address

Street Address line 2

CityRegion

Postal / Zip Code
TRUSTEE'S DETAILS

It is required by law to have a trustee appointed for beneficiary less than 18 years of age.
Name of Trustee*

First NameLast Name
Address (Postal)*

Example: P.O. Box 1234

Example: AN Accra-North

CityState / Province

Postal / Zip Code
Phone Number of Trustee*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
Please enter a valid email address
Special G O O D N E S S awaits YOU!
JOIN A SOCIAL GROUP OR FAMILY
*

End RegistrationSpecial GOODNESS
Join NOW!*

FAMILYSOCIAL GROUP
Name of Social Group*
Please provide the details of the executive members
1st Executive *

First NameLast Name
Phone Number (Mobile)*
Please enter a valid phone number.Format: (000) 000-0000.
2nd Executive

First NameLast Name
Phone Number (Mobile)
Please enter a valid phone number.Format: (000) 000-0000.
Name of Family*
Name of Primary Card Holder*

First NameLast Name
Card Number (Primary Card Holder)Publish*
Enter 16-Digits on your Card
*

I have read and agree to the Terms & Conditions
*

I have read and agree to the Terms & Conditions
Please verify that you are human*
Should be Empty: