PHILIPPINE AIR TRAFFIC CONTROLLERS’

MULTI-PURPOSE COOPERATIVE (PATCOMC)

Civil Aviation Authority of the Philippines Cmpd, NAIA Rd, Pasay City 1300 / Tel. No.8531280
Cooperative Development Authority (CDA) Registration No.9520-16008254
AFFILIATION: Tagalog Cooperative Development Center (TAGCODEC)
National Confederation of Cooperatives (NATCCO)

MEMBERSHIP APPLICATION FORM 1x1”

DATE : Photo
TO : The PATCOMC Board of Directors

Dearest Directors,
Request that I may be granted membership in the PHILIPPINE AIR TRAFFIC CONTROLLERS’ MULTI-
PURPOSE COOPERATIVE (PATCOMC). My personal data are as follows:

(Given Name) (Middle Name) (Last Name)

Present Home/Mailing Address:

Provincial Address:
Date of Birth: CAAP Unit: Position:
Office Address/Place of Assignment:
Educational Attainment: Tax Identification No.:
CONTACT INFORMATION:
Mobile/Phone No.: Office Phone No.:
E-mail Address/FB Account:
(*Please update us whenever changes are made)
Civil Status:
Name of Spouse (if Married):
Name of Dependent/s Relationship Age/ Date of Birth

Herewith is my membership fee of TWO HUNDRED PESOS (Php 200.00) which amount shall be returned to
me should my application be rejected.

Should my application be approved, I will do my duties as prescribed by the By-Laws and obey the rules
and regulations provided by Republic Act No. 9520, the decisions of the General Assembly and the Board of
Directors, and policies and decisions that may be promulgated by the Cooperative Development Authority
(CDA).

Signature of Applicant

Approved By: Recorded By:

Chairperson Board Secretary

Date Approved:
Board Resolution No: