APPLICATION FOR MEMBERSHIP

I hereby apply for membership in __________________________________ .And agree to obey its rules
and regulations as set down in its by-laws, policies and the amendments thereof, likewise the decisions of the
body during general, regular and or special membership meetings.
I have paid the required membership fee of ₱ ___________only.
I also hereby pledge to subscribe initially_____share/s with a par value of one hundred pesos only (₱
100.00) with the equivalent amount of ____________________________________ (P _______) as my capital
stock of the said cooperative. Likewise, I swear to pay the amount of ___________________________ (₱
_________) equivalent to ____share/s as my initial paid-up capital. I promised to pay the balance of my
subscription weekly/monthly/quarterly/semi-annually or yearly installments.
____________________________________________________________
(Signature above Printed Name of the Applicant)
PERSONAL DATA:

FIRST NAME MIDDLE NAME LAST NAME

Present Address: ________________________________________________________________________________
Date OF Birth: ______________________________Civil status: _______________ Age: ______ Gender: ________
Place of Birth: _______________________________________________________Cell phone No.________________
Highest educational Attainment: ________________________________ Occupation: ________________________
Skills: __________________ Monthly Salary Rate: ________________ Other Income: ________________________
No. of Dependent: ____ Nearest Relative: _________________________________________ Relationship: ________
Ethnic Affiliation: ________ Organizational Affiliation: _______________
LIST OF DEPENDENTS/BENEFICIARIES:
NAME BIRTHDAY AGE RELATIONSHIP
1.
2.
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5.
6.
7.
8.
This application is approved/ disapproved by the Board of Directors during the meeting held on_____________ at
______________________________________________.
Registration Fee: ___________O.R. No. _______________Transferred from: __________________
Date Issued: ______________Issued by: ______________ Account Number: __________________

Prepared by: Attested by:

____________________ ______________________
Secretary Chairman