House No. 89, Star Oil Filling Station Building, Baatsonaa +233 (0)302 817 384

Kindly fill the form below

Applicant Information Full name
Home Address
Postal Address
Telephone Numbers

Email Addess
Occupation & Title / Position
Gender


Marital Status
Your plan options Select your preferred Vertex Legal Plan:
Monthly Dues GH¢ 32.00 GH¢ 59.00 GH¢ 84.00 GH¢ 107.00
Equates to: 50hrs
(GH¢ 25,000)
100hrs
(GH¢ 50,000)
150hrs
(GH¢ 75,000)
200hrs
(GH¢ 100,000)
Monthly Dues GH¢ 59.00 GH¢ 84.00 GH¢ 107.00
Equates to: 100hrs
(GH¢ 50,000)
150hrs
(GH¢ 75,000)
200hrs
(GH¢ 100,000)


Please select your preferred mode of payment

Full name of spouse
Date of Birth
Do you have any dependent children who have never been married? If so, their details:

1. Name
Date of Birth
2. Name
Date of Birth
3. Name
Date of Birth
4. Name
Date of Birth

Is there any other child under your care for whom you are legal guardian? If so, details:
Name
Date of Birth


Do you agree to Vertex Legal Protection's choice of appointed lgal representative for all services provided under your preferred plan?


Do you agree to surrender any court cost awarded in any legal action in which you are involved under your Plan to Vertex Legal Production?
Your Legal History In the past, have you ever been a party to any legal proceedings, civil or criminal, of whatever nature?

Are you currently a party to any legal proceedings, civil or criminal, of whatever nature?
(if yes, please provide details of those legal proceedings)

In the last one year, have you been aware of any cause, event or circumsstance which may give rise to claim against you or for which you would like to take legal action against as third party within the next six(6) months to one(1) year?
Specific Additional Information Contract Disputes
In your employment or personal life are you regularly a signatory to contracts?

In the last six(6) months, have you had cause to question or have been questioned over performance to a contract which you are personally involved?
(if yes, please provide details)


Criminal Matters
Have you been or are you currently under investigation by any lawfully constituted security service or agency such as the police, EOCO, BNI or the National security?
(if yes, please provide details)

Have you ever been arrested, charged or convicted in relation to a crimanal offence in Ghana or elsewhere?
(if yes, please provide details)

Have you ever been involved in or been questioned by a security service agency over a motor traffic offence?
(if yes, please provide details)


Employment Disputes
Are you an employer?

As an employer, have all your workers other than casual workers been issued with contracts of employment?

As an employer, do you have an established disciplinary procedure at your workplace?

Are you an employee?

As an employee, have you been issued with a contract of employment?

As an employee, have you ever suffered wrongful dismissal or sexual harassment or discriminatory practices or had a serious grievance with any supervisor or colleague worker withing the last year?
Declaration I hereby warrant that the above statements are true to the best of my knowledge and belief and that Vertex Legal Protection shall be informed of any material alterations immediately. If such statements and particulars are written by any other person, I warrant that such person be deemed to be my agent for the purpose of filling in the same. I hereby agree that this Declaration shall form, subject to its acceptance and approval, the basis of the contract between me and Vertex Legal Protection and I am willing to accept such contract on the terms, conditions and exceptions therein stated. I accept that this contract shall not come into force until the Effective Date specified under the contract subject to my meeting all the conditions therein stated and I agree that in the event of any misrepresentation or a failure to disclose a material fact, this contract may be rendered null and void.
Name:
Date:

Contact Information

House No. 89, Star Oil Filling Station Building, Baatsonaa – Spintex.

+233 0302817384

+233 204052940

P.O. Box 9320, KIA – Airport, Accra.

info@vertexlegalprotection.com

vertexlegalprotection.com

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