Republic of the Philippines Document Code QFR-QOP-09-01

DEPARTMENT OF LABOR AND EMPLOYMENT Issue No. 02

Regional Office No. 2 Revision No. 00
Tuguegarao City, Cagayan Page No. Page 1 of 2
Date Effective April 2, 2018

APPLICATION FOR REGISTRATION

PART I. INFORMATION ABOUT THE APPLICANT ASSOCIATION Date Accomplished:

To be accomplished by the applicant association. Supply all required
information. Misrepresentation, false statement or fraud in this Application
Form or in any supporting document is a ground for denial or April 15, 2019
cancellation of Registration.
Name of Applicant Association Address

ASSOCIATION OF RETIRED TEACHERS TUMAUINI ,ISABELA 3325

Name of President Address

(Last) (First) (Middle Name)
BARANGAY MALIGAYA, TUMAUINI ISABELA 3325
GUZMAN, GAVINO, CALIGUIRAN

Date Organized Date of CBL Ratification (if ratification was done on

(Day) (Month) (Year) successive dates, state date of ratification)
(Day) (Month) (Year)
18 DEC. 2014
20 03 1915
Place/s of Operation
No. of Members 8300000000
TUMAUINI ISABELA Male 10
Female 73

Composition of Members. Please check appropriate category

[ ] Agricultural Workers ( <>
farmers <> fisherfolk <> <>
arisans Othes ___________)
[ ] Small Transport Workers (drivers <> jeepney <> <>
FX tricycle <>
pedicab)
[ ] Homebased/Homeworkers
[ ] Small construction workers
[ ] Vendors ( <> market <>
sidewalk <> ambulant)
[ ] Small-scale miners
[/] Others/Own-Account, Pls. specify RETIRED TEACHERS

Fiscal Period Status of Finances

[ ] Calendar Year [ ] Fiscal Year (pls. [ ] w/ Financial Report [ ] w/o Financial Report
specify) N/A
I attest to the truth of the foregoing.

ISABEL B. PAGUIRIGAN- ADVISER

Authorized Representative/Position in the Association
(Signature over printed name)

SUBCRIBED AND SWORN TO before me at TUMAUINI, ISABELA , Philippines this __________ day of
____________ 2019, by _____________________________with Community Tax Certificate

NOTARY PUBLIC
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