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CDA-SEU-

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Cooperative Development Authority


Cooperative Annual Progress Report (CAPR)
As of December 31, _______

INSTRUCTIONS TO COOPERATIVES

1. All blanks shall be filled-up with appropriate information. Do not leave any field blank. Write 0 for none and N/A
Applicable, dates should be written in mm/dd/year
2. The submission of the duly accomplished Cooperative Annual Progress Report (CAPR) Form shall be done ANNUA
days after the end of the calendar year.
3. Submission to CDA shall be done electronically through www.cda.gov.ph in accordance with MC No. 2014
cooperative shall submit to the Authority, through the Extension Office, one (1) copy of the encoded CAPR Form
days after the end of the calendar year.

4. The Authorized Representative of the Cooperative shall encode all the data required in the CAPR Form.
5. The Chairman and General Manager shall certify to the truthfulness and correctness of the information

contained herein.
6. All Multi-Purpose Cooperatives shall segregate records per economic activity.

GENERAL INFORMATION

A. Cooperative Identification Number (CIN):

B. Name of Cooperative as of latest amendment:

C. Present Address of Cooperative:

D. Registration Number (under RA 9520):

E. Date Registered:
Original Date of Registration :
Registration Date under RA 9520 :

F. Business Permit (as of reporting period)


Business Permit No.
Date Issued
Amount Paid

G. Category of Cooperative: Primary Secondary

H. Type of Cooperative: (click to select) Agriculture


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I. Asset Size of Cooperative: Micro (with Assets of below P3,000,000 )

(Pls. check only one item) Small (with Assets of P3,000,001 to P15 million)

Medium (with Assets of P15,000,001 to P50 million)

Large (with Assets over P50 million)

J. Common Bond of Membership: (click to select) Occupational

K. Date of General Assembly:

L. Quorum Requirement:

M. Fiscal Year:

N. Area of Operation: National Regional Municipal

O. Business Activities:

O1. Annual Volume of Business: (select only business activities undertaken (maybe more than one) and indic
per business activity)

Business Activity Bases of Volume of Business


Consumer/Canteen & Catering Gross Sales
Labor Service/deployment of members Total Contract Price
Lending Total Amount of Gross Loan Releases
Marketing/Trading (non-agri products) Gross Sales
Production/Manufacturing Gross Sales
Training Providers Gross Receipts
Sale of Agricultural Products Gross Sales
Provision of Services (please click below)
Practice of Profession, pls. specify
___________ Gross Service Revenue /Income
Professional Gross Service Revenue /Income
Transportation Gross Service Revenue /Income
add more service activities

O2. Products/Commodities
Put check mark/s for the Use drop down to choose Check either the
Major Products Specific Products raw or pro

Crops Banana

Aqua Marine Crabs Prawn

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Livestocks Pig Ducks

Metal /Minerals Lime Bronze

Other Products & Bamboo Copra Dairy


Commodities

O3 Other Financial Services

D Money Transfers D Foreign Exchange Trading D Bills P


D Remittances D ATM Operations D Others

N3. Services Rendered (please specify) To delete

O4. Importation Activities, if any, identify:


Import items
Volume of Importation

P. Information on Number of Employees


Current Year
Male Female
Number of Personnel Receiving Salaries
Number of Personnel receiving Honoraria
only

Note: In case of Workers Cooperative, all workers are considered direct employees of the cooperative.
For honoraria -do not include officers receiving honoraria

Q. Contact Person (at the time of submission)


a. Name:
b. Designation:
c. Phone Number:
d. Fax Number:
e. Email Address:

R. Information on Membership
For Primary
For Secondary For Tertiary
Primary Co- Secondary
Particulars Male Female ops Co-ops
No. of Regular members
No. of Associate members
Total No. of Members

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R1. MEMBERSHIP COMPOSITION: (Please select composition from the drop down and indicate number of mem
in each composition)

Composition No. Composition


Agrarian Reform Beneficiaries
Entreprenuers
Farmers

add more

R2. AGE GROUP OF MEMBERS


Age bracket No.
18 - 30
31 - 59
60 and above

R3. List of Officers - Officers as of the Reporting Period (Indicate name and address)

R3.a. Board of Directors


NAME ADDRESS
1. CHAIRMAN -
2. VICE-CHAIRMAN -
3
4
5
6
7
8
9
10
11
12
13
14
15

R3.b. Other Officers


NAME ADDRESS
SECRETARY -
TREASURER -
GENERAL MANAGER -

R4.c. Committees of the Cooperative

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NAME ADDRESS
A. AUDIT COMMITTEE
1
2
3
B. ELECTION COMMITTEE
1
2
3
C. MEDIATION AND CONCILIATION COMMITTEE
1
2
3
D. ETHICS COMMITTEE
1
2
3
E. OTHER COMMITTEES (Please specify)
1
2
3
4
5

S. Information on Cooperative Branches/Satellites


No. of Branches:
No. of Satellites:

S1. Details of Cooperative Branch/es


Name/Address of Branch Office
Date of Issuance

S2. Details of Cooperative Satellite


Name/Address of Satellite Office
Date of Issuance

T. Laboratory Cooperative

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No. of Members
Name and Address of Laboratory
Cooperative Male Female
Student Non- Student Student Non- Student

T1. Activities of Laboratory Cooperative


Activities /Services

T2. Information on Deposit Liabilities of Laboratory Cooperative

No. of Members with


Type of Deposits No. of Accounts
deposit accounts

Savings deposits
Time deposits
Other types of deposits, please specify
Total

U. Information on Number of Units Owned/Managed by Transport Cooperatives

Units Owned by the Units Owned by Members and


Units/Vehicles Transport Coop Managed by Cooperative

Number of Units

V. Information on Transactions to Members/Non-Members

Gross Sales / Receipts Members Non-Members

Amount of Gross Sales/Receipts

W. Certificate of Compliance (COC)


COC No. Date of Issue

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X. Certificate of Tax Exemption/Ruling


CTE No.
Date Issued:
Validity:
TIN

Y. Information on Deposit Liabilities


Regular Members Associate M

No. of
Type of Deposits Members No. of Members
with No. of Accounts Total Amount with deposit
deposit accounts
accounts

Savings deposits
Time deposits
Other types of deposits, please specify
Total

V. Information on Capitalization
Common Preferred
Authorized Capital
Subscribed Capital
Paid-up Capital to be deleted
Deposit for Capital Subscription
Par Value per Share
Treasury Shares

Z. Information of Actual Taxes Withheld/Remitted to BIR (Total for the whole year)
Taxes withheld and remitted for Employees Salary/Compensation
Taxes withheld and remitted for Honorarium
Expanded Withholding Taxes
VAT Payments / Percentage Taxes
Income Taxes Paid
Other Taxes Paid, please specify

AA. Affiliations
Name of Federations/Unions Address

AA1. Information on the Utilization of CETF - LOCAL

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Name of Activity/ies Date of Activity No. of Members Benefitted

AA2. Information on the Remittances of CETF to Federations/Unions

Name of Federations/Union Amount Re

AA3. Information on the Utilization of Community Development Fund

Name of Activity/ies Beneficiaries Date of Activity

AA4. Information on the Utilization of Optional Fund

Name of Project/Activity Date of Project/Activity

AB. Risk Pooling Activities (activities that cover protection against death, injury and illness, loss of property, and
events.

Name of Program Partner/Insurance Provider No. of member-


beneficiary

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Prepared By: _________________________________________


Position

Accountant
Bookkeeper
Compliance Officer

Certified True and Correct:

General Manager Chairman

Page 9 of 60
CDA-SEU-FR-003
Revision No. 4
Effectivity Date: ___________, 2017

evelopment Authority
nnual Progress Report (CAPR)
er 31, _______

ONS TO COOPERATIVES

Do not leave any field blank. Write 0 for none and N/A for Not

ual Progress Report (CAPR) Form shall be done ANNUALLY within 120

h www.cda.gov.ph in accordance with MC No. 2014-05. Likewise, the


nsion Office, one (1) copy of the encoded CAPR Form within within 120

ncode all the data required in the CAPR Form.


uthfulness and correctness of the information

r economic activity.

Secondary Tertiary

Page 10 of 60
CDA-SEU-FR-003
Revision No. 4
Effectivity Date: ___________, 2017

edium (with Assets of P15,000,001 to P50 million)

Others, pls. specify

tivities undertaken (maybe more than one) and indicate total amount

Amount

Check either the products are


raw or processed

raw processed

raw processed

Page 11 of 60
CDA-SEU-FR-003
Revision No. 4
Effectivity Date: ___________, 2017

raw processed

raw processed

raw processed

Bills Payment
Others, pls. specify
_______________

TOTAL

direct employees of the cooperative.

Other Juridical Persons

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CDA-SEU-FR-003
Revision No. 4
Effectivity Date: ___________, 2017

tion from the drop down and indicate number of members

Composition No.

ADDRESS

ADDRESS

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CDA-SEU-FR-003
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Effectivity Date: ___________, 2017

ADDRESS

Certificate of Authority
No.

Letter of Authority No.

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CDA-SEU-FR-003
Revision No. 4
Effectivity Date: ___________, 2017

Recognitio Date Issued


n No.

Total Amount

Total

Total

Valid Until

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CDA-SEU-FR-003
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Effectivity Date: ___________, 2017

Associate Members

No. of Total
Accounts Amount

Total

Total

Address

Page 16 of 60
CDA-SEU-FR-003
Revision No. 4
Effectivity Date: ___________, 2017

Amount Utilized

Amount Remitted

Amount Utilized

Amount Utilized

gainst death, injury and illness, loss of property, and other contingent

Amount

Page 17 of 60
CDA-SEU-FR-003
Revision No. 4
Effectivity Date: ___________, 2017

d True and Correct:

Page 18 of 60
Cooperative Development Authority
Cooperative Annual Progress Report (CAPR)
As of December 31, _______

INSTRUCTIONS TO COOPERATIVES

1. All blanks shall be filled-up with appropriate information. Do not leave any field blank. Write 0 for none and N/A
Applicable, dates should be written in mm/dd/year
2. The submission of the duly accomplished Cooperative Annual Progress Report (CAPR) Form shall be done ANNUA
days after the end of the calendar year.
3. Submission to CDA shall be done electronically through www.cda.gov.ph in accordance with MC No. 2014
cooperative shall submit to the Authority, through the Extension Office, one (1) copy of the encoded CAPR Form w
the end of the calendar year.

4. The Authorized Representative of the Cooperative shall encode all the data required in the CAPR Form.
5. The Chairman and General Manager shall certify to the truthfulness and correctness of the information

contained herein.
6. All Multi-Purpose Cooperatives shall segregate records per economic activity.

GENERAL INFORMATION

A. Cooperative Identification Number (CIN):

B. Name of Cooperative as of latest amendment:

C. Present Address of Cooperative:

D. Registration Number (under RA 9520):

E. Date Registered:
Original Date of Registration :
Registration Date under RA 9520 :

F. Business Permit (as of reporting period)


Business Permit No.
Date Issued
Amount Paid

Page 19 of 60
G. Category of Cooperative: Primary Secondary

H. Type of Cooperative: (click to select)

I. Asset Size of Cooperative: Micro (with Assets of P3,000,000 and below )

(Pls. check only one item) Small (with Assets of P3,000,001 to P15 million)

Medium (with Assets of P15,000,001 to P100 million)

Large (with Assets over P100 million)

Note: Land should be excluded from the Total Asset as per CDA MC 2007-07 dated June 5, 2007.

J. Common Bond of Membership: (click to select) Institutional

K. Date of General Assembly:

L. Quorum Requirement:

M. Fiscal Year:

N. Area of Operation: National Regional Municipal

O. Business Activities:

O1. Annual Volume of Business: (select only business activities undertaken (maybe more than one) and indic
per business activity)

Business Activity Bases of Volume of Business


Consumer/Canteen & Catering Gross Sales
Labor Service/deployment of members Total Contract Price
Lending Total Amount of Gross Loan Releases
Marketing/Trading (non-agri products) Gross Sales
Production/Manufacturing Gross Sales
Training Providers Gross Receipts
Sale of Agricultural Products Gross Sales
Provision of Services (please click below)
Practice of Profession, pls. specify
___________ Gross Service Revenue /Income
Professional Gross Service Revenue /Income

Page 20 of 60
Transportation Gross Service Revenue /Income
add more service activities

O2. Products/Commodities
Check either produ
Major Products Use drop down to choose Specific Products process

Crops Banana Corn


Aqua Marine Crabs Mussles

Livestocks Pig Ducks Goat

Metal /Minerals Lime Gold Iron

Other Products & Bamboo Copra Flowers


Commodities

O3 Other Financial Services

Money Transfers Foreign Exchange Trading Bills P


Remittances ATM Operations Others

O4. Importation Activities, if any, identify:


Import items
Volume of Importation

P. Information on Number of Employees


Current Year
Male Female
Number of Personnel Receiving Salaries
Number of Personnel receiving Honoraria
only

Note: In case of Workers Cooperative, all workers are considered direct employees of the cooperative.
For honoraria -do not include officers receiving honoraria

Q. Contact Person (at the time of submission)


a. Name:
b. Designation:
c. Phone Number:

Page 21 of 60
d. Fax Number:
e. Email Address:

R. Information on Membership
For Primary
For Secondary For Tertiary
Primary Co- Secondary
Particulars Male Female ops Co-ops
No. of Regular members
No. of Associate members
Total No. of Members

R1. MEMBERSHIP COMPOSITION: (Please select composition and indicate number of members in each compos

Composition No. Composition


Agrarian Reform Beneficiaries
Driver / Operators / Conductors
Elderly/Senior Citizen
4Ps Beneficiaries
Livestock growers
4Ps Beneficiaries
4Ps Beneficiaries add more

R2. AGE GROUP OF MEMBERS


Age bracket No.
18 - 30
31 - 59
60 and above

R3. List of Officers - Officers as of the Reporting Period (Indicate name and address)

R3.a. Board of Directors


NAME ADDRESS
1. CHAIRMAN -
2. VICE-CHAIRMAN -
3
4
5

Page 22 of 60
6
7
8
9
10
11
12
13
14
15

R3.b. Other Officers


NAME ADDRESS
SECRETARY -
TREASURER -
GENERAL MANAGER -

R4.c. Committees of the Cooperative


NAME ADDRESS
A. AUDIT COMMITTEE
1
2
3
B. ELECTION COMMITTEE
1
2
3
C. MEDIATION AND CONCILIATION COMMITTEE
1
2
3
D. ETHICS COMMITTEE
1
2
3
Page 23 of 60
E. OTHER COMMITTEE (Please specify)
1
2
3
4
5

S. Information on Cooperative Branches/Satellites


No. of Branches:
No. of Satellites:

S1. Details of Cooperative Branch/es

Name/Address of Branch Office


Date of Issuance

S2. Details of Cooperative Satellite

Name/Address of Satellite Office


Date of Issuance

T. Laboratory Cooperative
No. of Members
Name and Address of Laboratory
Cooperative Male Female
Student Non- Student Student Non- Student

Page 24 of 60
T1. Activities of Laboratory Cooperative
Activities /Services

T2. Information on Deposit Liabilities of Laboratory Cooperative

No. of Members with


Type of Deposits No. of Accounts
deposit accounts

Savings deposits
Time deposits
Other types of deposits, please specify
Total

U. Information on Number of Units Owned/Managed by Transport Cooperatives

Units Owned by the Units Owned by Members and


Units/Vehicles Transport Coop Managed by Cooperative

Number of Units

V. Information on Transactions to Members/Non-Members

Gross Sales / Receipts Members Non-Members

Amount of Gross Sales/Receipts

W. Certificate of Compliance (COC)

COC No. Date of Issue

X. Certificate of Tax Exemption/Ruling

CTE No.

Date Issued:

Page 25 of 60
Validity:

TIN

Y. Information on Deposit Liabilities


Regular Members Associate M

No. of
Type of Deposits Members No. of Members
with No. of Accounts Total Amount with deposit
deposit accounts
accounts

Savings deposits
Time deposits
Other types of deposits, please specify
Total

Z. Information of Actual Taxes Withheld/Remitted to BIR (Total for the whole year)
Taxes withheld and remitted for Employees Salary/Compensation
Taxes withheld and remitted for Honorarium
Expanded Withholding Taxes
VAT Payments / Percentage Taxes
Income Taxes Paid
Other Taxes Paid, please specify

AA. Affiliations
Name of Federations/Unions Address

AA1. Information on the Utilization of CETF - LOCAL

Name of Activity/ies Date of Activity No. of Members Benefitted

Page 26 of 60
AA2. Information on the Remittances of CETF to Federations/Unions

Name of Federations/Union Amount Re

AA3. Information on the Utilization of Community Development Fund

Name of Activity/ies Beneficiaries Date of Activity

AA4. Information on the Utilization of Optional Fund

Name of Project/Activity Date of Project/Activity

AB. Risk Pooling Activities (activities that cover protection against death, injury and illness, loss of property, and
events.

Name of Program Partner/Insurance Provider No. of member-


beneficiary

Page 27 of 60
Prepared By: _________________________________________
Position

Accountant
Bookkeeper
Compliance Officer

Certified True and Correct:

General Manager Chairman

Page 28 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

evelopment Authority
nnual Progress Report (CAPR)
er 31, _______

ONS TO COOPERATIVES

Do not leave any field blank. Write 0 for none and N/A for Not

ual Progress Report (CAPR) Form shall be done ANNUALLY within 120

h www.cda.gov.ph in accordance with MC No. 2014-05. Likewise, the


ion Office, one (1) copy of the encoded CAPR Form within 120 days after

ncode all the data required in the CAPR Form.


uthfulness and correctness of the information

r economic activity.

Page 29 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

Secondary Tertiary

edium (with Assets of P15,000,001 to P100 million)

Others, pls. specify

tivities undertaken (maybe more than one) and indicate total amount

Amount

Page 30 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

Check either products are raw or


processed

raw processed
raw processed

raw processed

raw processed

raw processed

Bills Payment
Others, pls. specify
_______________

TOTAL

direct employees of the cooperative.

Page 31 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

Other Juridical Persons

tion and indicate number of members in each composition)

Composition No.

ADDRESS

Page 32 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

ADDRESS

ADDRESS

Page 33 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

Certificate of Authority
No.

Letter of Authority No.

Recognitio Date Issued


n No.

Page 34 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

Total Amount

Total

Total

Valid Until

Page 35 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

Associate Members

No. of Total
Accounts Amount

Total Amount

Address

Amount Utilized

Page 36 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

Amount Remitted

Amount Utilized

Amount Utilized

gainst death, injury and illness, loss of property, and other contingent

Amount

Page 37 of 60
CDA-SEU-FR-003
Revision No. 5
February 7, 2017

d True and Correct:

Page 38 of 60
Crops Aqua Marine Livestocks Metal /Minerals Other Products /Commodities

Abaca Crabs Carabao Bronze Bamboo


Banana Lobsters Chicken Coal Cacao
Calamansi Mussles Cow Copper Copra
Cassava Oysters Ducks Diamond Dairy
Coconut Prawn Goat Gold Farm Inputs/implements
Coffee Seaweeds Pig Iron Flowers
Corn Shrimps Sheep Lime Gravel, stone, pebble
Garlic Squid Others, Pls specify __________ Nickel Handicrafts
Ginger Fish, Pls specify ______ Silver Herbs
Mango Other Aquamarine, Pls specify ___________ Others, Pls specify Mushroom
Onion Palm oil
Palay Rattan
Papaya RTW
Peanut Water Refilling
Pineapple Rootcrops, Pls specify ________
Rubber High value vegetables, pls specify
Sugarcane Other Fruits, Pls specify _______
Tobacco Others, please specify ________
Tomato Common Bond of membership
Associational
Institutional
Occupational
Residential

Type of cooperative

1 Advocacy
2 Agrarian Reform Beneficiaries
3 Agriculture
4 Consumer
5 Coop Banks
6 Credit
7 Dairy
8 Education
9 Electric
10 Financial Service
11 Fishermen
12 Health
13 Housing
14 Insurance
15 Labor Service
16 Marketing
17 Multi Purpose
18 Producers
19 Professional
20 Service
21 Small Scale Mining
22 Transport
23 Water Service
24 Workers
25 Others

Services

Medical
Dental
Hospitalization
Transportation
Insurance
Housing
Electric
Water
Communication
Consultancy
Rental of Equipment/Office Space
Practice of Profession, pls. specify ___________
Others, please specify ___________
Other Products /Commodities

Farm Inputs/implements

Gravel, stone, pebble


Handicrafts

Mushroom

Water Refilling
Rootcrops, Pls specify ________
High value vegetables, pls specify ______
Other Fruits, Pls specify ________
Others, please specify ________
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11

Cooperative Development Authority


Cooperative Annual Progress Report (CAPR)
As of December 31, _______

INSTRUCTIONS TO COOPERATIVES
1. All blanks shall be filled-up with appropriate information.
2. The submission of the duly accomplished Cooperative Annual Progress Report (CAPR) Form shall be done ANNUA
within 120 days after the end of the calendar year.
3. Submission to CDA shall be done electronically through www.cda.gov.ph in accordance with MC No. 2014-05. L
the cooperative shall submit to the Authority, through the Extension Office, one (1) copy of the encoded CAPR Form
five (5) days from the electronic submission duly signed by the Accountable Officer.

4. The Authorized Representative of the Cooperative shall encode all the data required in the CAPR Form.
5. The Chairman and General Manager shall certify to the truthfulness and correctness of the information
contained herein.
6. All Multi-Purpose Cooperatives shall segregate records per economic activity.
7. Do not leave blank. Write 0 for none and N/A for Not Applicable

GENERAL INFORMATION

A. Cooperative Identification Number (CIN):

B. Name of Cooperative as of latest amendment:

C. Registration Number (under RA 9520):

D. Date Registered:
Original Date of Registration :
Registration Date under RA 9520 :

E. Business Permit
Business Permit No.
Date Issued
Amount Paid

F. Present Address of Cooperative:

G. Category of Cooperative: Primary Secondary

H. Type of Cooperative:

I. Common Bond of Membership:

Page 43 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11

J. Date of General Assembly:

K. Quorum Requirement:

L. Fiscal Year:

M. Area of Operaion: National Regional Municipal Others, pls.

N. Business Activities: (Please specify)

_________________________________ ____________________________________
_________________________________ ____________________________________
_________________________________ ____________________________________
_________________________________ ____________________________________
_________________________________ ____________________________________

N1. Products/Commodities
N2. Services Rendered (please specify)
N3. Annual Volume of Business:

Business Activity Amount

O. Information on Number of Employees


Current Year
TOTAL
Male Female
Salaried Personnel
Honoraria

Note: In case of Workers Cooperative, all workers are considered direct employees of the cooperative.
For honoraria - include no. of officers receiving honoraria

P. Information on Number of Volunteer Current Year


TOTAL
Workers Male # of days Female # of days
Volunteer

Note:Volunteers are members rendering services to the cooperative without salary/honoraria.

Q. Contact Person
Page 44 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11

a. Name:
b. Designation:
c. Phone Number:
d. Fax Number:
e. Email Address:

R. Information on Membership
For Primary For
Secondary For Tertiary Other Juridical P
Particulars Male Female Primary Secondary
No. of Regular members
No. of Associate members
Total No. of Members
Target/Potential Membership

R1. MEMBERSHIP COMPOSITION: (Please specify)

Composition No. Composition

Page 45 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11

R2. List of Officers (Indicate name and address)

R2.a. Board of Directors


NAME ADDRESS
1. CHAIRMAN -
2. VICE-CHAIRMAN -
3
4
5
6
7
8
9
10
11
12
13
14
15

R2.b. Other Officers


NAME ADDRESS
SECRETARY -
TREASURER -
GENERAL MANAGER -

R2.c. Committees of the Cooperative


NAME ADDRESS
A. AUDIT COMMITTEE
1
2
3
B. ELECTION COMMITTEE
1
2
3
C. MEDIATION AND CONCILIATION COMMITTEE
1
2
3
D. ETHICS COMMITTEE
1
2
3
E. OTHER COMMITTEES (Please specify)

Page 46 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11

1
2
3
4
5

R3. Information on Cooperative Branches/Satellites


No. of Branches:
No. of Satellites:

R4. Details of Cooperative Branch/es


Address of Branch Office No. of Members Date of Certificate of Au
Male Female Issuance No.

Page 47 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11

R5. Details of Cooperative Satellite


Address of Satellite Office No. of Members Date of
Male Female Issuance Letter of Author

R6. Laboratory Cooperative

Name and Address of Laboratory No. of Members Recognitio


Type of Members
Cooperative n No.
Male Female

R7. Financial Aspect of Laboratory Cooperative


Sevices of Laboratory Cooperative Deposit Liabilities

R8. Information on Deposit Liabilities of Laboratory Cooperative

No. of Members with


Type of Deposits No. of Accounts Total Amou
deposit accounts

Savings deposits
Time deposits
Other types of deposits, please specify
Total

S. Certificate of Good Standing (CGS)


S1. Regular CGS
CGS No. Date of Issue Valid Unti

S2. Special CGS


CGS No. Purpose Date of Issue Valid Unti

Page 48 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11

T. Certificate of Tax Exemption/Ruling


CTE No.
Date Issued:
Validity:
TIN

U. Information on Deposit Liabilities


Regular Members Associate Members

No. of No. of
Type of Deposits Members No. of Total Members with No. of
with Accounts Amount deposit Accounts
deposit accounts
accounts

Savings deposits
Time deposits
Other types of deposits, please specify
Total

V. Information on Capitalization
Common Preferred Total
Authorized Capital
Subscribed Capital
Paid-up Capital
Deposit for Capital Subscription
Par Value per Share
Treasury Shares

W. Information of Actual Taxes Withheld/Remitted to BIR Total


Employees Salary/Compensation
Honorarium
Interest on Share Capital
Other Taxes, pls. specify

X. Information on Statutory Reserves

Amount utilized for the year Accumulated Balance

General Reserve Fund


CETF
CETF - Local
Remitted to Federation/Union
Community Development Fund
Optional Fund

Page 49 of 60
CDA-SEU-FR-003
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Effectivity Date: February 11

Prepared By: _________________________________________


Position

Accountant
Bookkeeper
Compliance Officer

Certified True and Correct:

General Manager Chairman

Page 50 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

ve Development Authority
ve Annual Progress Report (CAPR)
mber 31, _______

NS TO COOPERATIVES
on.
Annual Progress Report (CAPR) Form shall be done ANNUALLY

gh www.cda.gov.ph in accordance with MC No. 2014-05. Likewise,


e Extension Office, one (1) copy of the encoded CAPR Form within
y the Accountable Officer.

ll encode all the data required in the CAPR Form.


he truthfulness and correctness of the information

s per economic activity.


Applicable

Tertiary

Page 51 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

Others, pls. specify

____________________________________
____________________________________
____________________________________
____________________________________
____________________________________

Amount

TOTAL

red direct employees of the cooperative.

TOTAL

Page 52 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

Other Juridical Persons

No.

Page 53 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

ADDRESS

ADDRESS

ADDRESS

Page 54 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

Certificate of Authority
No.

Page 55 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

Letter of Authority No.

Date Issued

Deposit Liabilities

Total Amount

Valid Until

Valid Until

Page 56 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

Associate Members

Total
Amount

Total

Total

Accumulated Balance

Page 57 of 60
CDA-SEU-FR-003
Revision No. 3
Effectivity Date: February 11, 2015

True and Correct:

Page 58 of 60
Agrarian Reform Beneficiaries
Barangay officials and employees
Driver / Operators / Conductors
Diferrently Abled Person/PWD
Elderly/Senior Citizen
Entreprenuers
4Ps Beneficiaries
Farmers
Fishermen/fisherfolks/fish vendors
Government employees and officials
Housewives/Househusbands
Livestock growers

Indigeneous People, pls. specify ____________

Informal Settlers
Military Personnel
Non-uniformed Military Personnel
Miners
Teachers/Educators
Non-teaching personnel
Overseas Filipino Workers
Private Employees
Professionals
Rebel Returnees
Religious Sector/Worker
Retired Employees/Retirees
Seaman/Seafarers
Self-employed, pls. specify nature
Skilled workers, pls. specify
Students
Vendors
Others, Pls. specify ___________________
`Business Activities
Appliance trading
Auto Supply buy and sell/trading
Bags Making
Bakery
Banana Production
Beauty and wellness services

Bee Equipment and Supply Inputs, Beekeeping

broom making/rag making/glove making


Buco Pie Production
CABLE SERVICE

CANAL CLEARING SERVICES AND DISSILTING

Canteen and Catering


Car Rental Service
Cargo Handling
carwash
Cattle Dispersal, Farm Implements
CHARCOAL TRANSPORTATION
Casket making
Cold Storage

Collection from Connection Fees, Penalties

Comfort room services


Common Service Facilities Rental

Conduct trainings and seminar to coop leaders

Dormitory
DRYING
duck egg selling
Emission Testing
Enrichment Program
Feed Milling Venture
Feeds Distribution
Ferrying of Visitors/Tourists

FILTERNET AND SPILL BOOM MAINTENANCE

Fishing
Food Processing
FUEL REFILLING STATION

funeral and related activities