Visa Pre-Paid Registration Form

adansi visa prepaid card

Complete the form below to register for the Prepaid Visa Card

Title(Required)

Specify Title(Required)

Surname(Required)

Your Surname

Other Names(Required)

First name & Middle Name

Preferred Name on Card(Required)

Hidden

Which currency do you want the card in?(Required)

Phone(Required)

Email(Required)

Marital Status(Required)

Nationality(Required)

Date of Birth(Required)

Legal Guardian

If not above 18 year

Place of Birth(Required)

ID Type(Required)

ID Number(Required)

Issue Date(Required)

Expiry Date(Required)

Residence Permit (If not Ghanaian)

Employer Details

Tax Identification Number (TIN) / Ghana Card Number(Required)

House Number

Please don't input Digital Address number

Nearest LandMark

eg: Near Dansoman Last Stop