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BRGY.

SAN VICENTE SENIOR CITIZENS ASSOCIATION


Brgy. San Vicente, Matagob, Leyte

Attached
APPLICATION FOR MEMBERSHIP 1 x 1 Photo

Name: _____________________________ Age: ____ Sex: ____ OSCA ID No. _________________

Civil Status: _______________ Birthdate: ________________ Birthplace: _____________________

Name of Wife/Husband/Benefactor: ___________________________________________________

No. of Children: ________________________

Highest Educational Attainment: ______________________________________________________

Skills: ______________________________ Occupation: ___________________________________

Source of Income: _______________________ Annual Income: _____________________________

If living with benefactor, please fill-up this portion:

Relation with Benefactor: _____________________________ Occupation: _____________________

Total Monthly Income of Benefactor:


____________________________________________________

No. of Children/Dependents of Benefactor: ______________________________________________

This serves as my application for membership with the elderly association


_______________________________________, and thus I do hereby promise to abide by the rules
and regulation of the association in accordance with the Constitution and By-Laws of the
organization.

_______________________________
Name of Applicant/Signature

______________________________
Date of Application

__________________________________
BRGY. SAN VICENTE SENIOR CITIZENS ASSOCIATION
Brgy. San Vicente, Matagob, Leyte

Name & Signature of Administering Officer

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