CHECKLIST OF REQUIREMENTS

Name of FCA: ___________________

Address: _______________________
Name of Chairman/ President: _____
Contact Number/s: _______________

With (/)
Item or
Type of Document Remarks
No. Without
(x)
1. Letter of Intent
2. Board Resolution
Valid certificate of Registration
3.
DOLE___ SEC___ CDA___
4. MAFC Endorsement
5. MAO Endorsement
6. LCE Endorsement (Mayor)
7. Profile of FCA
7.a. List of farmer members (Table 1).
7.b. List of Existing Machinery (Table 2).
8. PGLU Accreditation (Sangguniang Panlalawigan)
 NAME OF ASSOCIATION
ADDRESS OF OFFICE
REGISTRATION NUMBER

Date: ____________

ANNIE Q. BARES, DVM

Regional Executive Director
Department of Agriculture
Regional Field Office 1

Dear Director Bares,

Nowadays, mechanization is vital for Agricultural crop production. Farm mechanization allows
faster production more food to be grown and harvested and saving labor and cost. Farm
equipment and machineries are at the heart of the Agricultural industry.

In line with Department of Agriculture’s program of ensuring our county’s food security, We the
Name of Association___________ of Address of the Association would like to signify our
interest to apply for the following Agricultural Machineries.

1. __________________________________
2. __________________________________
3. __________________________________
4. __________________________________
5. __________________________________

These machineries will improve our productivity, save postharvest losses and will advance our
Agricultural development. These are our main reasons why we are desirous to acquire these
farm implements with the help of your good office.

We are looking forward for your consideration regarding our request. Thank you and have a
blessed day.

Very truly yours,

_________________________
President/ Chairperson

Contact Number: _______________________

 REPUBLIC OF THE PHILIPPINES
PROVINCE OF LA UNION
MUNIPALITY OF BAUANG

NAME OF ORGANIZATION
SEC REGISTRATION NO: ________________________

A RESOLUTION TO REQUEST ASSISTANCE FROM THE DEPARTMENT OF

AGRICULTURE REGIONAL FIELD OFFICE I THROUGH DR. ANNIE Q. BARES, REGIONAL
EXECUTIVE DIRECTOR, DA-RFO1.

BOARD RESOLUTION No: __________

Series of _______

WHEREAS, the Name of the Association with address at Address of the Association
realizes that having control over all aspects of its crop production activities is the only way to
advance for Agricultural development;

WHEREAS, to improve its productivity and save postharvest losses, the Name of Association
needed to acquire basic production and postharvest such as:

Rank according to
Technologies Number of Units
priority of needs

COMBINE HARVESTER

4 WHEEL TRACTOR

MOBILE CIRCULATING DRIER

HAND TRACTOR WITH TRAILER

WHEREAS, the Name of Association has a total of ___ hectares, intended for its Type of
Crops crop production;

WHEREAS, the Name of Association has ___ farmer-members that will be directly benefit
under the project and has access to the services of expert personnel to manage and operate
the said machinery/ facilities;

WHEREAS, the Name of Association has available cash for the revolving fund/ initial
operating cost amounting to ₱_______________.

NOW THEREFORE, on motion of ___________________________ and duly seconded by

______________________, it is hereby RESOLVED that the Name of Association is
requesting assistance from THE DEPARTMENT OF AGRICULTURE REGIONAL FIELD
OFFICE I THROUGH DR. ANNIE Q. BARES, REGIONAL EXECUTIVE DIRECTOR, DA-RFO1.
For the acquisition of the above requested technologies.
RESOLVED FURTHER, That Mr./Ms. ____________________________ President of the
___________________________, shall be designated as the authorized representative to
transact with the PGLU and/ or sign documents for and in behalf of the Name of Association
with respect to the requested assistance, with his/ her three (3) specimen signatures shown
below this resolution.

APPROVED, This ___ day of _____, 2024 in Barangay of Association.

I hereby CERTIFY to the correctness of the foregoing resolution.

Secretary: _____________________

Approved:

_________________
President

THREE SPECIMEN SIGNATURE OF AUTHORIZED REPRESENTATIVE:

1. __________________ 2. __________________ 3. ___________________