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Clogsag Wel Loan Form

The document is an application form for a welfare loan from CLOGSAG National Headquarters. It requests personal details, organizational details, loan request details, bank details, MDA endorsement, applicant's declaration, and documents to attach. It contains sections for applicant's name, date of birth, next of kin details, amount requested, purpose of loan, repayment period, bank account details, MDA confirmation, applicant's certification, and a checklist of required documents.

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info.atsukwame
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821 views2 pages

Clogsag Wel Loan Form

The document is an application form for a welfare loan from CLOGSAG National Headquarters. It requests personal details, organizational details, loan request details, bank details, MDA endorsement, applicant's declaration, and documents to attach. It contains sections for applicant's name, date of birth, next of kin details, amount requested, purpose of loan, repayment period, bank account details, MDA confirmation, applicant's certification, and a checklist of required documents.

Uploaded by

info.atsukwame
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PLACE

CLOGSAG WELFARE LOAN PASSPORT


Application Form PICTURE
CLOGSAG National Headquarters: P.O. Box M336, Accra – Ghana HERE
Tel: +233(0)302 676307 / 631584 Email: info@clogsag.org

1.0 PERSONAL DETAILS

Name of Applicant Staff ID

Date of Birth DD MM YYYY Mobile No.

Email Please Is CLOGSAG Dues Deducted from Your Salary? YES NO

Next of Kin Relationship

Next of Kin Mobile No. Next of Kin Email

2.0 ORGANIZATIONAL DETAILS


Name of Ministry/ Dept/ Agency (MDA)

Postal Address

Telephone Number

3.0 LOAN REQUEST

Amount in words

GHS

Purpose

Proposed Loan Repayment Period

4.0 BANK DETAILS

Name of Bank

Account Name

Account Number Branch


5.0 MDA ENDORSEMENT

The ………………….....…………………………………………………………………… (Name of MDA) here


confirms and warrants that the information provided on this form is true and not misleading as
at the date of this application; that the applicant is an employee of this organization and that all
particulars provided to the best of my knowledge are correct.

I hereby commit to ensuring that as long as the applicant remains indebted to the firm for the
loan, consistent monthly deductions will be made. Additionally, in the event of resignation,
voluntary retirement, death, termination of appointment or dismisal and vacation of post from
the Public Service, a three-month notice will be provided to the firm. During this period,
satisfactory arrangements/agreements will be reached for the complete settlement of the loan.

Head of Department
Name ………..……………………………………………………………………..
OFFICIAL STAMP
Signature …………………………………………………………………………

(Contact Tel No.) ………………………………….………………………………….

6.0 APPLICANTS DECLARATION


I hereby certify that all the information provided above is true and complete. I also agree to be
bound by the conditions of the loan.
I hereby declare that in the event of resignation, voluntary retirement, death, termination of
appointment or dismisal and vacation of post from the Public Service, any entitlements/gratuity
and benefits due me should be used to defray the outstanding loan balance as of the date of
occurance of the afforementioned events.

Name: ……………………………………………………………………………………………………………..

Signature: …………………………………………. Date: DD MM YYYY

Documents to attach include:


Current Pay Slip, Passport Picture, Mandate Form and OTP, Coloured Copy of Ghana
Card(ECOWAS ID), Evidence of Bank Details
*OTP: Once the mandate form is generated, CAGD will dispatch an OTP via text. Kindly write the
OTP on the mandate form before submission.

7.0 OFFICE USE ONLY

Verified By: …………………………………………………………………… Signature: ………………………………….


Date: ……………………………………

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