MABUHAY EMPLOYEES SAVINGS AND CREDIT

COOPERATIVE
Prk. 8B Curvada, Magdum, Tagum City
Tel. No. 216-0443

MEMBERSHIP APPLICATION & PROFILE

PHOTO
The Board of Directors
MEMPC
Tagum City
Gentlemen:

MEMBERSHIP AND SUBSCRIPTION AGREEMENT

I, ____________________________________ a resident of________________________________ hereby

Agree to be a member of MESCC Cooperative. I understand the purpose and/or objectives of this cooperative. In this connection
with such membership, I hereby agree to the following terms and/or conditions:
1.) To put up the required paid up capital of P 5,000 for regular member.
2.) To participate in the following :
a.) Subscribed at least _____ shares valued ____________________( P__________) and paying for them
either in lump sum or in regular installment thru salary deduction.
b.) Coterminous agreement the employees who tender resignation from the company, shall expel from the
membership of MESCC, where shareholding shall be answerable for any liabilities to the Cooperative
and Company.
c.) No partial withdrawal of capital share, unless employees who tender resignation.
3.) To follow the rules of MESCC regarding the operating policies of the Cooperative.

The provisions of this agreement, the bylaws of cooperative have been explained to me and understood them as I agree
to abide with all of them.

PERSONAL INFORMATION:

Name (Last Name) __________________________ Date upon fill-up _______________________

(First Name) __________________________ Educational Level _______________________
(Middle Name) ____________________________ Occupation __________________________
Address (No./Prk./St.) ____________________________ Position __________________________
( Dist.Brgy.) ____________________________ Employer /Co. __________________________
(Mun./City) ____________________________ Branch Assigned __________________________
(Province) ____________________________ Address __________________________
Date of Birth ____________________________ Office Cellphone No.__________________________
Place of Birth ____________________________ Business Name __________________________
____________________________ Business Address __________________________
Sex ( ) Male ( ) Female _________________________
Civil Status ( ) Single ( ) Married ( ) Widow/er Business Tel. No. _________________________
( ) Separated ( ) Single-Parent Type of Profession _________________________
Religion ____________________________ Mo. Gross Income _________________________
Mobile/Tel. No. ____________________________ Mo. Net Income _________________________
No. of Persons in the Household ____________________ SSS No. _________________________
Type of Residence ( ) Owned ( ) Rented ( ) Mortgaged TIN No. _________________________
( ) Family-Owned ( ) Owned-by-Parents Pag-ibig/PHIC No. _________________________
FAMILY INFORMATION:

Relationship: ( Last , First Middle ) Date of birth Sex Civil Status Occupation
Spouse
Child 1
Child 2
Child 3
Child 4
Member’s Parents
Father
Mother
Other Dependents/Beneficiaries

________________________________ _____________________________
Applicant Signature over Printed Name Spouse Signature over Printed Name

Capital Share: P ____________

Please check the box below, your capital share contribution thru salary deduction either;

Lumpsum P _________ 6 Months P________ 12 Months P _________ Others P __________

 AUTHORIZATION
FOR VOLUNTARY PAYROLL DEDUCTION

I, _________________________________ hereby authorize _______________________________ to

(Employee’s Name) (Employer)

deduct from my wages for __________________________________________________________

(Reason of deduction)

the sum of _____________________, beginning ________________ and ending ________________

(Amount) (Date) (Date)

until the total amount of _________________ has been deducted.

(Amount)

In the event my employment ends for any reason before the final deduction is made, the entire
monetary obligation shall be deducted to: such as Final Salary, Coop Share, & 13 th month pay.

___________________________ _____________
Employee’s Name & Signature Date signed