ANNEX A

Name of Cooperative Registered Address

Branch
Count Region Province /Branch Registered
Code
based on CDA registration Address

A B C D E F
1 000 NCR Manila MANILA MULTIPURPOSE COOPERATIVE Malate, Manila
1 000 NCR Manila MANILA MULTIPURPOSE COOPERATIVE Malate, Manila
1 000 NCR Manila MANILA MULTIPURPOSE COOPERATIVE Malate, Manila
1 000 NCR Manila MANILA MULTIPURPOSE COOPERATIVE Malate, Manila
1 001 R-III Pampanga MANILA MULTIPURPOSE COOPERATIVE San Fernando, Pampanga
1 001 R-III Pampanga MANILA MULTIPURPOSE COOPERATIVE San Fernando, Pampanga
1 002 R-IV Laguna MANILA MULTIPURPOSE COOPERATIVE Calamba, Laguna
002 R-IV Laguna MANILA MULTIPURPOSE COOPERATIVE Calamba, Laguna

Prepared By: Verified/Validated By:

_______________________ ____________________________________
Compliance Officer/Accountant Manager/Chief Executive Officer
 CDA Certificate of Registration (If amended, post the latest date of
amendment based on issued latest COR)

Taxpayer
Identification No.
000-000-000-000 With CTE
Latest Date of
Original Date of Latest Amendment (Y/N)
No.0000-00000000 Amendment
Registration No. Just write Y
(mm/dd/yy)
or N

G H I J K L
9520-1400001 01/03/1975 05/20/2020 123-321-213-000 Y
9520-1400001 01/03/1975 05/20/2020 123-321-213-000 Y
9520-1400001 01/03/1975 05/20/2020 123-321-213-000 Y
9520-1400001 01/03/1975 05/20/2020 123-321-213-000 Y
9520-1400001-01 9520-1400001-01 10/6/2020 123-321-213-001 N
9520-1400001-01 9520-1400001-01 10/7/2020 123-321-213-001 N
9520-1400001-02 9520-1400001-02 12/20/2020 123-321-213-002 N
9520-1400001-02 9520-1400001-02 12/20/2020 123-321-213-002 N

Attested By:

_______________
Chairperson
 Certificate of Tax Exemption

Start of Effectivity End of Effectivity

Date Issued Date of Tax Date of Tax
CTE No. Status of CTE
(mm/dd/yy) Exemption (first Exemption
issued CTE) (latest CTE issued)

M N O P Q
12345 05/30/2018 valid 06/30/2013 5/30/2023
12345 05/30/2020 valid 06/30/2013 5/30/2023
12345 05/30/2020 valid 06/30/2013 5/30/2023
12345 05/30/2020 valid 06/30/2013 5/30/2023
 Type of Transactions Number of
Business Activities (members only, non - Cooperatives
(Business Activity- members or both) (Branches) (copy and
singular only, so it paste per line of
Category of
Type of Cooperative will not be lump) activity) (in main
Cooperative
(breakdown each office one line only)
business undertaking Members & (no need to input
per main/branch) Members Only Non Members number in the
branch/es rows)

R S T U V W
Multipurpose coop Primary Lending Y 2
Multipurpose coop Primary Consumer Y 2
Multipurpose coop Primary Water Services Y 2
Multipurpose coop Primary Others- Rental y 2
Multipurpose coop Primary Consumer Y
Multipurpose coop Primary Lending y
Multipurpose coop Primary Water Services Y
Multipurpose coop Primary lending y
 Net Sale / Services / Interest Income (Total
(one line only))
Gross Sales/Receipts (Net Sales = Gross Sales - Sales Returns and
Allowances and Sales Discounts)
General Reserve
Fund
(accumulated)
(as of _______)
Non- Total Non- Total
Members Members
members (Y+Z=AA) members (AB+AC=AD)

X Y Z AA AB AC AD
760,000.00 12,356,333.00 -
760,000.00 3,564,803.00 650,000.00 4,214,803.00 3,364,000.00 650,000.00 4,014,000.00
760,000.00 23,365.00 50,000.00 73,365.00 23,365.00 50,000.00 73,365.00
760,000.00 25,000.00 25,000.00 50,000.00 25,000.00 25,000.00 50,000.00
50,000.00 20,000.00 70,000.00 50,000.00 20,000.00 70,000.00
2,000,000.00 2,000,000.00 2,000,000.00 2,000,000.00
300,000.00 300,000.00 300,000.00 300,000.00
1,500,000.00 1,500,000.00 1,500,000.00 1,500,000.00

Cost of Sales / Services
(To apportioned based on the
percentage of Y and Z)
Gross Revenue (include Other
Income) (one liner)
(Net Sales/Services/Interest
Income - Cost Sales/Services +
Other Income)
Expenses
(To apportioned based on the Net surplus for Alloca
percentage of Y and Z)

Total
Total Total
Non- (AE+AF=AG) Non- Non-
Members Members (AH+AI= Members (AK+AL= Members
members members members
AJ) AM)

AE AF AG AH AI AJ AK AL AM AN
Net surplus for Allocation Allocations for statutory distribution
Allocation
for Interest Allocation for Patronage
on Share Refund (PR)
for for Capital (ISC)
for General Education Communit for
Non- Total
Reserve and y Optional
members (AN+AO= AP)
Fund Training Developm Fund
Fund ent Fund
Members Members Non-Members
AO AP AQ AR AS AT AU AV AW
100,000.00 10,000.00 10,000.00 3,000.00 7,000.00 49,000.00 16,000.00 5,000.00
 TOTAL
Actual Income tax Actual Vat
ISCPR
paid Payments
(AU+AV+AW)

AX AY AZ
70,000.00