Professional Documents
Culture Documents
Gender:
Status:
Home Address :
Business Address:
Tel/Mobile No.:
Fax No.:
Mobile Number:
Email Address:
(please include amount of principal loan for the first loan and for the last 3 loans only)
Loan Cycle
A partnership among:
Month/Year of Release
How will you describe the repayment record of the nominee on previous and current loans?
Please provide a document that will show the nominees repayment record including missed amortization payment (if any).
(Please provide a list of the nominees business assets using the attached pro-forma table)
As a nominee for the Special Award for Community Leadership, please describe your participation and contribution
to the development of your community. (Use additional sheets if necessary)
Part of the cash prize for this Award must be reinvested in the community of the awardee through a proposed
activity/program by the winner that will be approved by the award organizers. Please describe your proposed
activity. (Use additional sheets if necessary)
How many people does the business employ (including paid family members)?
(If available, please provide the list of employees in separate sheet/s)
(If available, please provide photocopy of records. Please provide estimates if records are unverifiable.)
(If available, please provide photocopy of records. Please provide estimates if records are unverifiable.)
(If available, please provide photocopy of records. Please provide estimates is records are unverifiable.)
2
(If available, please provide photocopy of records. Please provide estimates if records are unverifiable.)
One of the eligibility criteria for the Award is that the nominee is a model citizen of the community with high moral
standards and exhibiting socially responsible behaviour. In what ways does the nominee meet this requirement?
(Use additional sheets, if necessary)
Note: Please submit together with this nomination form a short write-up and pictures of the nominee and his/her business/es.
Accomplished nomination forms are to be submitted to the head office of your MFI on
or before July 6, 2015.
Create a Screening Committee to select the five (5) most outstanding nominees from
your MFI. Rank the nominees from 1 to 5 using the MFI Monitoring Form. Submit the
nomination forms, write-ups, pictures, and the MFI Monitoring Form to your network on
or before July 13, 2015.
3
(Please refer to the next page for guidelines on how to complete the assets table)
Note: For nominees with multiple businesses, please complete a separate table for each type of business.
Business 1:
Year
purchased
Purchase Price
Year
purchased
Purchase Price
Total
Business 2:
Total
4
Please use purchase price for equipment, vehicle/s, and furniture/appliances used in business.
http://financial-dictionary.thefreedictionary.com/Business+Assets
Year Purchased
2004
2006
2001
Purchase Price
PhP15,000
PhP480,000
PhP1,699
PhP300,000
PhP30,000
PhP826,699