ST.

VINCENT PARISH MULTI-PURPOSE COOPERATIVE

Dupax del Sur, Nueva Vizcaya

CO-OP MUTUAL ASSISTANCE PROGRAM

APPLICATION FOR MEMBERSHIP

2 x 2 ID picture

The Board of Directors

St. Vincent Parish Multi-Purpose Cooperative
Dupax del Sur, Nueva Vizcaya

SIR/MADAM:

I wish to apply for membership in the Parish Mutual Assistance, a

welfare service scheme of the St. Vincent Parish Multi-Purpose Cooperative, I
hereby agree to faithfully abide and comply with the rules and regulations, as
well as policies enacted by the Board of Directors, and decisions promulgated
by the general membership of the Program.

PERSONAL DATA
(Please fill-in all important details)

Name: ______________________________________ Age:______Civil Status: _________

(Last Name, First Name, Middle Name)
Date of Birth: ____________ Contact No.:_______________TIN:___________________
SSS/GSIS/VIN:___________________ Others (Pls specify) : ______________________
Occupation _____________________________ Employer __________________________
Postal Address ______________________________________________________________
Name of Spouse _________________________ Address ___________________________
Occupation _____________________________ Employer __________________________
Designated Beneficiary/ies __________________________________________________

Very truly yours,

______________________________
(Signature of applicant)
Date: ________________________

APPROVED:

NOEL S. AMADOR
Chairperson

JERREMY B. CASTAÑEDA VINCENT G. GONZALES EFREN G. COLOMA

Director Director Director

LOLITA G. SAGARIO OMER D. PUDIQUET AGNES P. RAMOS

Director Director Director
 APPLICATION FOR MEMBERSHIP
& MEMBERSHIP AGREEMENT

The Board of Directors

St. Vincent Parish Multi-Purpose Cooperative
Dupax del Sur, Nueva Vizcaya

Gentlemen:
I wish to apply for membership to the St. Vincent Parish Multi-Purpose
Cooperative. I have completed the training course prescribed for prospective members
and I understand the purpose and objective of this cooperative.
In connection with such membership, I hereby agree to the following terms and
conditions:
1. To comply with the provisions of the Articles of Cooperation, the Bylaws and
Policies set by the Board, the General Assembly, as well as directives of duly
constituted authorities;
2. To attend all meetings, conferences and training seminars as required by the
Board of Directors;
a. Fine, suspend or expel me from membership whereupon all my
shareholdings in SVPMPC, shall be answerable for my liabilities to the
said cooperative;
b. Cancel my rights and privileges of membership.
3. To participate in the planned thrift and savings program by:
a. Subscribing to at least _____ shares valued at
________________________ (P___________), and paying for them either
in lumpsum or regular installment;
b. Contributing to its share capital at least 50% of the annual interest and
patronage refund due me;
c. Contributing regularly to its capital build-up program and savings
mobilization.
4. To pay the membership fee of P 100.00, and Mutual Aid Plan of P 700.00;
5. To participate and involve myself in the activities of the SVPMPC for the
welfare of its members, and patronize its services.

Attached is my information sheet and certificate of training for your reference.

IN WITNESS HEREOF, I have hereunto affixed my signature this ________ day

of ___________________, 2020, at Dupax del Sur, Nueva Vizcaya.

_________________ ______________________________
Date (Signature over Printed Name)

A P P R O V E D:

NOEL S. AMADOR
Chairperson

JERREMY B. CASTAÑEDA VINCENT G. GONZALES EFREN G. COLOMA

Director Director Director

LOLITA G. SAGARIO OMER D. PUDIQUET AGNES P. RAMOS

Director Director Director
 ST. VINCENT PARISH MULTI-PURPOSE COOPERATIVE
Dupax del Sur, Nueva Vizcaya
MEMBER’S INFORMATION SHEET
1. Name _________________________________ Address____________________________
Place of Birth ___________________________ Date of Birth ______________________
Names Date of Birth
Spouse: _____________________________ _______________________
Children: ____________________________ _______________________
___________________________ _______________________
___________________________ _______________________
___________________________ _______________________
2. Highest Educational Attainment/Degree Received: ____________________________
3. Present Employment: __________________________ Annual Salary P ____________
4. Experience in Cooperative:
Inclusive Date Position Name of Cooperative
_______________________ ___________________ ______________________
_______________________ ___________________ ______________________
5. Training/Seminar on Cooperative (including SN) attended:
Date Course Description No. of Hours Place
____________ ______________________ _____________ ______________________
____________ ______________________ _____________ ______________________
6. Civic, Social and Religious Affiliation (Indicate position held):
___________________________________________________________________________
___________________________________________________________________________
7. Other Sources of Income:
a. Crop Production: Total Production Share Value
1. Major ____________ _____________ ___________ ______________
(Specify)
2. Secondary _________ _____________ ___________ ______________
b. Livestock Production (Specify):
1. ___________________________________ ______________
2. ___________________________________ ______________
3. ___________________________________ ______________
c. Others (Include income of spouse and children):
_____________________________________ ______________
_____________________________________ ______________
d. Real Estate Owned:
Kind Location Fair Market Value
________________ ________________________ _____________________
________________ ________________________ _____________________
8. Are you a permanent resident of the locality? _________ Yes ________ No.
If not, please give two addresses where you can be contacted when necessary:
______________________________________________________________________.
9. Have you ever been accused or convicted of any crime? If in the affirmation please
amplify:
__________________________________________________________________________.
10. Give the names and addresses of two reliable person who can vouch for your
character:
___________________________________________________________________________
___________________________________________________________________________
CERTIFICATION
I hereby certify that the above information is true and correct to the best of my
knowledge and belief. Signed this ____ day of __________________, 2020 at Dupax del
Sur, Nueva Vizcaya.

Signed in the presence of:

_______________________________
_________________________ (Signature of Member/Applicant)