COOPERATIVE HEALTH MANAGEMENT FEDERATION

Unit 102 Malakas Suites Bldg., No. 88 Malakas St., Brgy. Pinyahan, Diliman, Q.C.

CHECKLIST OF REQUIREMENTS
COOPERATIVE:
CONTACTS PERSON / NUMBERS:

Membership Information Sheet (updated)

Board Reso for Capital Share and for additional share (disregard if submitted)
CDA Registration Certificate (disregard if submitted)
BIR Registration Certificate (disregard if submitted)
Copy of Termination Letter from previous HMO provider if lateral transfer to waived the
contestability period of Pre-Existing Condition (If applicable) (disregard if submitted)
List of members enrolled from the previous HMO. (if applicable) (disregard if submitted)

List of BOD's, Officers and Employees with position (if theres changes from previous
submitted list)

Prepared by: Received By: