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Cocoa Research Co-operative Credit Union

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Cocoa Research Co-operative Credit Union Junior Savings Application

Junior Savings Application

Passport Photograph *

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Passport Photograph

Name of Parent (Contributor) *SOURCES OF CONTRIBUTIONS

Staff No

Occupation *

House No *

Division

Place of Work *

Tel *

GPS Address *

I promise to save at least GH¢ *

into “JSA” every month with effect from *

1. BENEFICIARIES OF JSA(Name of CHILD/ UNBORN CHILD) *BENEFICIARIES OF JSA (1st )

Gender *

AGE *

DATE OF BIRTH *

RELATIONSHIP *

Share of contribution *

2. BENEFICIARIES OF JSA(Name of CHILD/ UNBORN CHILD)BENEFICIARIES OF JSA (2nd)

SEX

AGE

DATE OF BIRTH

SHARE %

RELATIONSHIP

3. BENEFICIARIES OF JSA(Name of CHILD/ UNBORN CHILD)BENEFICIARIES OF JSA (3rd)

SEX

AGE

DATE OF BIRTH

RELATIONSHIP

SHARE %

4. BENEFICIARIES OF JSA(Name of CHILD/ UNBORN CHILD)BENEFICIARIES OF JSA (4th)

DATE OF BIRTH

AGE

SEX

SHARE %

RELATIONSHIP

5. BENEFICIARIES OF JSA(Name of CHILD/ UNBORN CHILD)BENEFICIARIES OF JSA (5th)

DATE OF BIRTH

AGE

SEX

SHARE %

RELATIONSHIP

Source of Deduction *

PARENT/DONOR’S SIGNATURE *

Start signing your signature here

DATE *

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