208 Eh epomeene PPLICATION ereby agree tO ci Patek Perth Mul-Purpoe Cooperaie ond herby the Sat Pati ror ewe, Rules ond Regulations, o» well oF Yo evrng Generel Rembert of he “I wish to opply for membership io genni bbe and comply with he Articles of Cooperation or Policies enocted by the Board of Directors, and decisfons promul MIDDLE NAME: iame:_LORIDELIA _Lorl TaganCwnlian/Regilered) “(Palayaw/Alyas) SF Gastone MAPDED —sex(F [JM — comacre 04034254249 FIRS! | ater 5 CONGUE LO BALILING SANTA. FE, Nueva Vicoya i hocks is Barangay Truntetpall } pate or sith: DEE Jo 1482 Place ot arin:_tonmel Baling Ste Fe TN: Highest Educational Attainment: _tHighGchoe| Graduate Religion: _Cnrist ry Occupation: _O+W Employer blake LARA WFARMER: (_ 0, Orchard Land Area: Location: (Please (_) b. Bangkag Land Are Location: check) ( )c.Tolon/Rice Field Lond Area: Location: ()d. OTHERS Lond Area: Location: Monthly Income: _30, 05) Other Source/s of Income (pis. specity):_ POULTRY. Name of Spouse: _ODONtS. CPAIRO. GALDONER OS AR TAST NAME Apaiyido] FIRST NAME (Wagan) TAIDDLE NAME FRRTRWTRTES Spouse Adcress: _(onguel ee Safe Wea. Vitcoya Date ofsith: _ Moy 02 14 Occupation - OFW Driver pai ee Uae # No. of DEPENDENTS: Z| you can use separate sheet itthe space provided is no! enough) NAME OF BENEFICIARIES DATE OF BIRTH RELATIONSHIP TO APPLICANT 1 Laide Maurice L. Odbnu Feb. 9 and Da 2 bys Celestine L. Ooones Dec. 29, 404 a 4 5 Very truly yours, Date Submitted Vlr-ay \ {a Signgture of Applicant PV0uTe A Be