MEMBERSHIP DATA BASE UPDATE

PERSONAL INFORMATION
Surname First Name Middle Name

NAME:
PHOTO
GENDER: Male Female LGBT QUEER
(mm/dd/yyyy)
DATE OF BIRTH: MARITAL STATUS: Single Married
NAME OF SPOUSE: Separated Widowed
PRESENT ADDRESS:
Owned Rented/Boarder Living wth Parent/Relatives
PERMANENT ADDRESS:
MOBILE NUMBER: HOME PHONE NUMBER:
BPI ACCOUNT NO: SA CA Position:
SSS ID NO: Division:
TIN: OFFICE EMAIL ADDRESS:
OFFICE ADDRESS:
EMPLOYEE ID NO: PERSONAL EMAIL ADDRESS:
DATE HIRED: OFFICE PHONE NUMBER:

FOR ACTIVE EMPLOYEE

CAPITAL BUILD-UP PLEDGE
I declare that the information herein above written is correct, further I have read and understood the policies, rules, regulations, etc if the Cooperative as stated in the
Website and other communication channels. I also agree to the terms and conditions therein contained.

I hereby subscribe to the ______ common shares at P100 per share and my contribution per payday of continued capital build-up is :

Share Capital: P400 per payday (minimum) ________________ (amount of choice not to exceed P10,000 per payday)
(Mandatory)
Save for
Retirement
P500 per payday (minimum)
Program ________________ (amount of choice not to exceed P10,000 per payday)
(Voluntary)
Savings Deposit:
P500 per payday (minimum)
(Voluntary) ________________ (amount of choice not to exceed P10,000 per payday)

This serves as an authorization for salary deduction for the above mentioned capital build-up program and any future loan amortization to be paid to ____________
hereafter , I acknowledge that I have read, understood and/or have been duly informed of the terms and conditions pertaining to the data privacy pratices of the
Cooperative as reflected in the Coop's Data Privacy Policy at www.alekbcmpc.com and I hereby express my full conformity thereto. I do understand and acknowledge
the fact that my accounts with ____________ are not insured nor guaranteed by Abbott Laboratories (Phils.) for each has a distinct and separate juridical personality.

SPECIMEN (1) (2) (3)

Printed Name of Member / Date SIGNATURES

IMMEDIATE MEMBERS OF MY FAMILY (Surname, First name, Middle name ) Use back page if space is limited
Fullname (Last,First,Middle) Date of Birth AGE Civil Status Relationship to the Member NOTE: IMMEDIATE MEMBERS OF THE FAMILY
only includes:
a.) FOR MARRIED MEMBERS: legitimate
spouse, legitimate children and parents.
b.) FOR SINGLE MEMBERS: parents and
unmarriedsiblings up to 21 years of age.
C.) IN-LAWS are excluded
* Disclaimer : If no beneficiaries nominated, ___________ will follow the legal heirs based ib the heirarchy rule: Spouse for married and parents for single member*

_______________ VALIDATION/APPROVAL
MEMBERSHIP COMMITTEE ENDORSEMENT
(To be filled out by _______________)
I certify that the above data are true and correct.
Membership ID No:
Signature over printed name
Membership Committee Received by:

Date: Encoded by:

NOTE: Please send the accomplished form to alekbc office or membership committee