AMPC Membership Form - Revised 2015

AGDAO MULTI-PURPOSE COOPERATIVE Head Office: AMPC Green Bldg., Corner Urduja & N. Torres St., Obrero, 8000 Davao City

Tel. Nos.: 300-3828 (telefax); 300-4355; 285-3797; 227-0248; 285-3805

MEMBERSHIP APPLICATION FORM

Recent 1x1 Picture

Branch PMES Certificate Number Date of Application

PERSONAL INFORMATION

LASTNAME FIRSTNAME MIDDLE NAME

Date of Birth (mm/dd/yy)

Place of Birth Height Weight ________ ________

Tax ID Number (TIN) SSS Number Other I.D.(specify) ____________________

ID No. _______________

Highest Completed Level of Education

No. Of Dependents Ages of Dependents

Present Address

Owned Rented Mortgaged

Others:_________________

Provincial Address (if different from home address) Do you own a vehicle? If yes, pls indicate details: Type: ___________________ Plate#______________

Length of Time at Present Address Contact Number/s Email Address

EMPLOYMENT/BUSINESS INFORMATION

Occupation

Length of Service/Date Started Employer/Business Name

Employer/Business Address

Contact Number/s

Which of the following comes closest to your monthly income in Philippine Pesos? Under 8,000 8000-15000 15,001-30,000

30,001-50000 50,001-100,000 Above 100,000

Employment Status Regular/Permanent Others

Contractual ________

SPOUSE’S INFORMATION

LAST NAME FIRST NAME MIDDLE NAME

Date of Birth Contact Number/s Occupation

Employer/Business Business/Employers’ Address/Contact Number

Monthly Income (In Pesos) Employment Status Length of Service/Date Started

REFERENCES

Name Address Telephone No. Relation

1.

2.

How did you hear about AMPC?

Referred by__________________________ Advertisement (radio, tv, print media) Events/Trade fair

Fliers/Information Drive Internet search/social media Others, pls. specify_____________________

Signature of Applicant

Approved by: Conforme:

Branch Manager/General Manager BOD Res. No./Date

Training Conducted By:

No. ___________

AMPC Membership Form - Revised 2015

HOUSE SKETCH

AMPC Membership Form - Revised 2015

SUBSCRIPTION AGREEMENT

That I, ______________________________________, of legal age, Filipino, and a resident of

__________________________________________________________, Philippines, do hereby voluntarily attest and declare:

1. That I have voluntarily manifested my intention to be admitted as a member of AGDAO MULTI-PURPOSE

COOPERATIVE (AMPC), a non-agricultural multi-purpose cooperative organized and existing under Philippine laws, registered

pursuant to Republic Act No. 9520, otherwise known as the Philippine Cooperative Code of 2008, under Cooperative

Development Authority (CDA) Registration No. 9520-11005117, with Head Office address at AMPC Green Building, Corner N.

Torres and P. Urduja Extension, Barangay P. Bangoy (formerly, Bo. Obrero), Davao City, Philippines, by complying with the

minimum requirements of membership and submitting all documentary requirements, among others, thereto;

2. That AMPC has made known and explained fully my rights and obligations of membership in this cooperative

as provided by the amended AMPC Articles of Cooperation and Bylaws in relation to Republic Act No. 9520, or the Philippine

Cooperative Code of 2008;

3. That one of my obligations as a member in AMPC is my faithful contribution and/or payment for the minimum

subscribed capital amounting to Fifteen Thousand Pesos (P15,000.00) within the period prescribed by the amended AMPC

Bylaws;

4. That I hereby voluntarily commit to pay fully the total subscription of sixty (60) shares equivalent to Fifteen

Thousand (P15,000.00) Pesos, Philippine currency, within a period of three (3) years from the date of my admission as a

member in AMPC on the basis of Paragraph (b), Section 5, Article II of the amended AMPC Bylaws entitled: “Membership;”

5. That I also undertake to comply with the mandate on continuous capital build-up as provided by Section 3,

Article VII entitled: “Capital Structure” of amended AMPC Bylaws, more particularly on the regular payment of minimum

subscribed share capital. Thus, in addition to my payment of initial share capital amounting to P1,000.00 as one of the

requirements upon admission as a member of AMPC, I voluntarily agree to pay at least the amount of Four Hundred Pesos

(P400) per month, which shall be credited in my share capital in the cooperative within a period of three (3) years or until the said

minimum amount of P15,000.00 shall have been fully paid based on the following schedule of payment: (Kindly check the space

of your choice provided before each item.)

_____a. Lump sum payment of P15,000.00

_____b. The amount of P400.00 monthly

_____c. The amount of P200.00 semi-monthly

_____d. The amount of P1, 200.00 quarterly

_____e. The amount of P2, 400.00 semi-annually

_____f. The amount of P20 daily

6. That I fully understand that my utter failure to pay the said minimum subscribed share capital in the amount of

P15,000.00 within a period of three (3) years affects my membership status in AMPC that is, I will NOT be considered as a

member in good standing and as such, I am NOT entitled to vote therein.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of _______________________, 201_ at

Davao City, Philippines.

_________________________________________

(Printed name and Signature)

AMPC Membership Form - Revised 2015

SUBSCRIPTION AGREEMENT

That I, ______________________________________, of legal age, Filipino, and a resident of

__________________________________________________________, Philippines, do hereby voluntarily attest and declare:

1. That I have voluntarily manifested my intention to be admitted as a member of AGDAO MULTI-PURPOSE

COOPERATIVE (AMPC), a non-agricultural multi-purpose cooperative organized and existing under Philippine laws, registered

pursuant to Republic Act No. 9520, otherwise known as the Philippine Cooperative Code of 2008, under Cooperative

Development Authority (CDA) Registration No. 9520-11005117, with Head Office address at AMPC Green Building, Corner N.

Torres and P. Urduja Extension, Barangay P. Bangoy (formerly, Bo. Obrero), Davao City, Philippines, by complying with the

minimum requirements of membership and submitting all documentary requirements, among others, thereto;

2. That AMPC has made known and explained fully my rights and obligations of membership in this cooperative

as provided by the amended AMPC Articles of Cooperation and Bylaws in relation to Republic Act No. 9520, or the Philippine

Cooperative Code of 2008;

3. That one of my obligations as a member in AMPC is my faithful contribution and/or payment for the minimum

subscribed capital amounting to Fifteen Thousand Pesos (P15,000.00) within the period prescribed by the amended AMPC

Bylaws;

4. That I hereby voluntarily commit to pay fully the total subscription of sixty (60) shares equivalent to Fifteen

Thousand (P15,000.00) Pesos, Philippine currency, within a period of three (3) years from the date of my admission as a

member in AMPC on the basis of Paragraph (b), Section 5, Article II of the amended AMPC Bylaws entitled: “Membership;”

5. That I also undertake to comply with the mandate on continuous capital build-up as provided by Section 3,

Article VII entitled: “Capital Structure” of amended AMPC Bylaws. Thus, in addition to my payment of initial share capital of

P1,000.00 as one of the requirements upon admission as a member of AMPC, I voluntarily agree to pay at least the amount of

One Hundred Pesos (P100) per month, which shall be credited in my share capital in the cooperative until the said minimum

amount of P15,000.00 shall have been fully paid based on the following schedule of payment: (Kindly check the space of your

choice provided before each item.)

_____a. Lump sum payment of P15,000.00

_____b. The amount of P100.00 monthly

_____c. The amount of P300.00 quarterly

_____d. The amount of P600.00 semi-annually

_____e. The amount of P1,200 annually

6. That in addition to P15, 000, I shall continue to invest in the share capital of the cooperative.

7. That I fully understand that the due and unpaid subscribed share capital shall be subject to fine of two percent

(2%) as determined by Board of Directors for every month of delinquency.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of _______________________, 20____ at

Davao City, Philippines.

_________________________________________

(Printed name and Signature)

Please do not fill below this line

---------------------------------------------------------------------------------------------------------------------------------- --------------------------------

No. Of Shares Paid Amount Paid No. Of Shares Subscribed Amount of Shares Subscribed Balance

Checked by: Date: ______________________________ _______________________________