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APPLICATION FORM FOR ACCREDITATION OF NGO

Sec. 108 (RA 7160)


Name of NGO : _________________________________________________
Address
: _________________________________________________
Tel. No.
:_________________________________________________
Date Organized : ______________________ Date Registered: ____________
Registering Agency: (Please check appropriate box)
(
(
(
(
(

) Securities and Exchange Commission


) Cooperative Development Authority
) Department of Labor and Employment
) Department of Social Welfare and Development
) Others, (Please specify) _____________________________________

NGO Organizational Level: (Please check applicable box)


( ) Community based
( ) Chapter
( ) Affiliate of a larger NGO: _____________________________________
( ) Others, (Specify) ___________________________________________
No. of Members: ______________
Purpose/Objectives (please use additional sheet if necessary)
_____________________________________________________________________________________
_____________________________________________________________________________________
Projects
______________
______________
______________
______________
______________
______________
______________

Cost
______________
______________
______________
______________
______________
______________
______________

Beneficiaries
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

Project Financing (Source/Schemes)


_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Services NGOs/POs/Private Sector Provide/ can participate in case. (Sec. 17 of RA 7160)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

List of members within the LGU: (Please use a separate sheet IF NECESSARY)

Linkages: (Check level and specify)


(
(
(
(

) Provincial___________________________________________________
) Regional____________________________________________________
) National____________________________________________________
) International ________________________________________________

We hereby certify to the correctness of the above information.


___________________
SECRETARY

ATTESTED:

_______________________
PRESIDENT
(3 copies: Municipal Office, DILG and NGO)