Tel.: 0302-968692/3 Email: [email protected] Website: www.npra.gov.gh/site Digital Address: GA-051-9940
NATIONAL PENSIONS REGULATORY AUTHORITY
APPLICATION FOR RENEWAL OF REGISTRATION AS PENSION FUND MANAGER
INSTRUCTIONS
Kindly read all instructions carefully before filling out this Form:
(i) All Sections of this Form should be filled accurately and boldly in CAPITAL letters.
(ii) Where field entries are not applicable, ‘N/A’ should be indicated in the space provided.
(iii) This Application should be signed by two (2) Directors of the Applicant and endorsed with an official
company stamp.
(iv) This Application should be accompanied by a cover letter on the company letterhead.
(v) An incomplete Application would not be processed.
(vi) All statutory documents required to be attached as copies to this Application must be duly certified and
initialed by the two (2) signatories to this application e.g. Tax Clearance Certificate, SSNIT Clearance etc.
(vii) The Dedicated Email Address of the Applicant under Part A of this Form, is the specific email address to
which all correspondence of the Authority would be sent for your information and action.
(viii) The Pension Fund Manager ID No. under Part A of this Form, is the number issued by the National Pensions
Regulatory Authority (“the Authority”) to the Pension Fund Manager upon registration (i.e.
NPRA/FM/xxxxx).
(ix) All Dates should be indicated in the following format: DD/MM/YYYY.
(x) For purposes of this application, the financial year is January to December of the immediate past year.
(xi) SSNIT Clearance Certificate is valid if obtained within the three (3) months prior to the submission of this
application.
(i) Tax Clearance Certificate is valid if obtained within the three (3) months prior to submission of the
application.
FOR OFFICIAL USE
RENEWAL FEE PAID:
All Submissions should be addressed to:
The Chief Executive Officer
National Pensions Regulatory Authority,
P. O. Box GP 22331, Accra.
9
th
Floor SU Tower, Ridge No.18 Castle
Road, Accra Ghana
DATE OF PAYMENT:
PAYMENT RECEIPT NO.:
OFFICER IN CHARGE:
NPRA/RR/PFM/2020
Page 2 of 4
PART A – PARTICULARS OF APPLICANT
1.
Name of Pension Fund Manager:
2.
Dedicated Email Address:
Primary Business
Location:
3.
Ghana Post Digital Address
(GPDA)- Attach Location Map
4.
Corporate Tel. No.:
Fax No.:
5.
Name of Chief Executive Officer:
Email Address:
Contact No:
6.
Name of Contact Person:
Designation:
Email Address:
Contact No:
7.
Pension Fund Manager ID No.*:
8.
SEC Investment Adviser Licence No.:
9.
Business Registration No.:
10.
Tax Identification No. (TIN):
11.
SSNIT Employer Registration No.:
12.
Valid Social Security Clearance Certificate Number:
13.
Valid Tax Clearance Certificate Number:
14.
Valid Data Protection Certificate Number:
PART B – PARTICULARS OF DIRECTORS
Item
Name of Director
Executive/Non-
Executive
Chairperson / CEO /
Independent
Date of Appointment
1.
2.
3.
4.
5.
6.
7.
8.
Page 3 of 4
PART C – INVESTMENT ADVISORY SERVICES
Kindly attach the list of Scheme(s) for which you provide Investment Advisory services as in the format
below:
NO.
NAME OF SCHEME
DATE OF APPOINTMENT
DATE OF EXPIRY
1.
2.
PART D – ATTACHMENTS
DOCUMENT (Certified True Copies of Docs 1- 3)
ATTACHMENT NO.
1.
SEC Investment Adviser Licence (July 01, 2020-June 30, 2021)
2.
Current Social Security Clearance Certificate
3.
Current Tax Clearance Certificate
4.
Corporate Annual Report (Audited)
5.
List of Scheme(s) to which you have been appointed
PART E – DECLARATION
We declare to the best of our knowledge and belief that, the information given in this application Form
is correct and complete. We certify that the documents attached to this application are true and
correct copies. We undertake to promptly notify the Authority of any matter which affects the validity
of any information given in support of our application. After the registration is renewed, we undertake
to promptly notify the Authority of any material changes to, or affecting the completeness or accuracy
of, the information provided in this form.
1
st
Signatory:
Name of Director: …………………….………………………………………………
Signature: …………………..…………………… Date: …………………
2
nd
Signatory:
Name of Independent Director: ……………………….……………………………………………
Signature: …………………..…………………… Date: …………………
NOTE: The Application for renewal of registration would be evaluated taking into consideration
your level of compliance with the National Pensions Act, 2008 (Act 766) as amended,
Official Company
Stamp / Seal
Page 4 of 4
Regulations made pursuant to the Act, all relevant Guidelines and the Authority’s
Administrative Directives.
