rCOMSDEP Cooperative Mining Scheme Registration Form
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Section A: Organization Information
Name of Organization
Registration Number
Type of Cooperative
Year of Establishment
Number of Members
Region
Select Region
Ashanti
Greater Accra
Central
Western
Eastern
Northern
Volta
Upper East
Upper West
Oti
Savannah
District / Municipality
Community / Town
Section B: Contact Information
Name of Cooperative Leader
Position / Title
Contact Number
Email Address
Office Address
Digital Address
Section C: Membership & Operations
Total Active Members
Percentage of Women Members
Main Mineral(s) of Interest
Current Stage of Operation
Site Location (GPS Coordinates)
Site Ownership / Lease Type
Section D: Technical & Safety Information
Do you have trained safety officers?
Yes
No
Do members use PPE?
Yes
No
Are there environmental safeguards?
Yes
No
Access to Technical or IT Support
Yes
No
Equipment Used
Section E: Support & Development Needs
Areas where support is needed
Any partnership or donor affiliations?
Preferred Mode of Communication
Section F: Declaration
Name of Declarant
Date of Submission
Section G: Document Uploads
Business / Cooperative Registration Certificate
Tax Identification (TIN) Document
Proof of Site Ownership / Lease Agreement
Mining License or Permit
Ghana Card of Cooperative Leader
Other Supporting Documents
Submit Registration
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