Application for Regular Membership Application for Regular Membership 493.26 KB Download Personal Information Email Last Name First Name Middle Name Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Age GenderMaleFemale Valid ID ( preferably TIN or SSS No. ) Contact Number Address Civil StatusMarriedSingleSingle but Head of FamilyWidowedSeparatedSolo Parent Educational AttainmentElementaryHigh SchoolVocationalCollegePost Graduate Course Degree Degree EmploymentGovernmentPrivate/OFWSelf-Employed Office Position Office Address Monthly Income Employer/Firm Position Office Address Monthly Income Primary Occupation Secondary Occupation Business Type Monthly Income Family Profile Household Member ( 1 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Age Occupation Monthly Salary BMPC MemberYesNo Household Member ( 2 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Age Occupation Monthly Salary BMPC MemberYesNo Household Member ( 3 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Age Occupation Monthly Salary BMPC MemberYesNo Household Member ( 4 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Age Occupation Monthly Salary BMPC MemberYesNo Household Member ( 5 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Age Occupation Monthly Salary BMPC MemberYesNo Real/Personal Property Own HousePermanentSemi-PermanentTemporary Home Lot Area FarmRiceCornSugarcaneCoconut Farm Lot Area VehicleCarMotorcycleTricycleOthers Please Specify BENEFICIARIES Beneficiary ( 1 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Beneficiary ( 2 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Beneficiary ( 3 ) Name Relationship Date of Birth ---123456789101112 ---12345678910111213141516171819202122232425262728293031 ---201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Occupational & Special Interest Skills Select Skills Rice FarmingCorn FarmingSugarcane FarmingAbaca ProductionOrchard FarmingLivestock RaisingPoultry RaisingCarpentryMasonryWeldingPlumbingElectricalCabinet MakingFurnitureUpholsterySewingDressmakingTailoringEmbroideryCookingFood ProcessingBeauticianManicure/PedicureHair StylingBarberMassagerWatch RepairElectronic RepairHome Appliance RepairHandicraft MakingBag MakingMechanincIron WorksRecycling Membership in Other Cooperatives Cooperative Name Cooperative Address Member’s Subscription Agreement In connection with my membership to this Cooperative, I hereby subscribe 100 Common/Preferred Shares valued at One Hundred Pesos (P100.00) per share or equivalent to Ten Thousand (Php 10,000) Pesos on the following terms and conditions. I agree to pay the initial amount of at least Five Hundred (P500.00) Pesos upon subscribing and the balance payable in monthly installment until the whole subscription is fully paid. I agree that the unpaid balance of my subscribed capital is my liability to this Cooperative. I agree that I could guarantee/sell a portion of my share capital to any member with prior approval by the Cooperative. I agree that I could make claims to my share capital contribution upon termination of membership without pending obligation and subject to the Cooperative applicable policies, systems and procedure. Undertaking I hereby agree and certify that the above information is true and correct Attachment Signature (Accepts *.jpeg, *.jpg, *.png and max. file size of 15mb)Note: Write you signature on white piece of paper and take a photo to be uploaded here. Photo ID (Accepts *.jpeg, *.jpg, *.png and max. file size of 15mb)Note: Upload your recent photo here.
