PHILIPPINE GOVERNMENT AUDIT SERVICE EMPLOYEES ASSN.

(PhilGASEA)
COA Compound, Commonwealth Avenue, Quezon City
Email add: philgasea@yahoo.com.ph / Tel. No. - 9328184

APPLICATION FOR MEMBERSHIP

ID picture taken
within
The Executive Board the last 6 months
(passport size)
PhilGASEA
Commission on Audit
Quezon City IMPORTANT: Accomplished
this form in three (3) copies
Gentlemen:
The undersigned regular employee of the Commission on Audit, have the honor to apply for membership in the Philippine
Government Audit Service Employees Association (PhilGASEA) constituted in pursuance of Section 3, Article XIII, of the
1987 Constitution of the Philippines and its implementing law, Executive Order No. 180.

In furtherance thereof, we hereby authorized the accounting Division, Regional Finance and / or Cash Division, COA
Central Office to cause the deduction from our respective salaries the amount of P10.00 representing our application fee,
and thereafter the amount of P10.00 each month as monthly dues both payable to the above mentioned Organization.

PERSONAL INFORMATION
SURNAME : CITIZENSHIP :
FIRST NAME : HEIGHT (m) :
MIDDLE NAME : WEIGHT (kg) :
DATE OF BIRTH (mm/dd/yyyy) : BLOOD TYPE :
GENDER (Male/Female) : Email Add :
CIVIL STATUS (Single/Married/Others __________) Tel. / Mobile No. :
PLACE OF BIRTH:
Permanent/City Address:

OFFICE BACKGROUND
COA I.D. No. : Office and Office Address:
Position / Designation :
Date Hired (Attached Appointment) :
Payroll (Centralized / Regional) : Office Tel. / Fax. No.
NCR / Regional Office No. :
FAMILY BACKGROUND
SPOUSE'S (Surname, First
Name, Middle Name)
: Tel. No. / Mobile No.:
Name of Children/s :
Father's Name : Tel. No. / Mobile No.:
Mother's Name :
ELIGIBILITY [CAREER SERVICE/ RA 1080 (BOARD/
EDUCATIONAL BACKGROUND BAR) UNDER SPECIAL LAWS/ CES/ CSEE]

College :
Graduate Studies :

Applicant: Approved: Noted by:

Printed Name & Signature Chairman, Committee on PhilGASEA President

Recruitment/Membership
Date: _______________ Date: _______________ Date: _____________