Membership and Subscription Agreement Form

Spouse:
Spouse Name

First NameMiddle NameLast Name
Spouse's Date of Birth

MonthDayYear
Date
Contact No.(Spouse)
Occupation.(Spouse)
Employer Name (Spouse)
Employer Address (Spouse)
Monthly Salary (Spouse)
Spouse Educational Attainment:

ElementarySecondaryHigh School LevelHigh School GraduateVocational GradCollege LevelCollege Graduate
Degree Course (Spouse)

Father:
Father's Name
Home Address
Father's Occupation
Father's Date of Birth

MonthDayYear
Date
Mother's Maiden Name:
Mother's Name
Mother's Date of Birth

MonthDayYear
Date
Home Address
Mother's Occupation

Beneficiary 1
Name M.I. Surname*
Relationship
Date of Birth

MonthDayYear
Date
Contact No.
Beneficiary 2
Name M.I. Surname
Relationship
Contact No.
Date of Birth

MonthDayYear
Date

Dependent 1
Dependent1. Name M.I. Surname
Dependent 1. Date of Birth

MonthDayYear
Date
Contact No.(Dependent 1)
Dependent 2
Dependent2. Name M.I. Surname
Dependent 2. Date of Birth

MonthDayYear
Date
Contact No.(Dependent 2)

Herewith is my:
Membership fee : Membership fee
Initial Savings Deposit : Initial Deposit
Share Capital/ Initial :  Share Capital
Passbook &ATM fee :    Passbook&ATM
TOTAL :   TOTAL

Which be amount shall be returned to me except the Membership and Passbook fee if I withdraw/expulsion/terminate as a member in this cooperative.

Should my application be approved, I will do my duties as prescribed by the By-Laws and obey the rules and regulations provided by Republic Act No. 6938, the decisions of the General Assembly and the Board of Directors, and policies and decisions that maybe promulgated by the Cooperative Development Authority (CDA).
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Printed Name*
Signature of Member

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Birth Certificate and/or Marriage Certificate if married

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MEMBERSHIP AND SUBSCRIPTION AGREEMENT
MM/DD/YYYY*

The BOARD OF DIRECTORS:
Bayanihan Hundred Islands Agrarian Reform Cooperative
L. Rivera Sr. St., Poblacion Alaminos City, Pangasinan

Ladies / Gentlemen:
I, Full Name* a resident of Address* ,hereby agree to be a member of the BHIARCo. I have completed the training course prescribed for prospective members and I understand the purposes and objectives of BHIARCo.

In connection with such membership, I hereby agree to the following terms and conditions:
1. To comply with the provisions of the Articles of Cooperation, the By-Laws and policies set by the Board of Directors and the General Assembly as well as acts of duly constituted authorities, and failure on my part to do so, the BHIARCo at its option: a. fine, b. suspend, or c. expel me from membership whereupon all my shareholdings in, shall be answerable for my liabilities to the BHIARCo;
2. Attend all meetings, conferences and seminars, as required by the Board of Directors and failure on my part to do so, unless previously excused by the Board, to pay the fine set forth by the Board in a resolution;
3. To participate in the planned thrift and savings program by:
  1. Subscribing for at least 50 shares valued at Five Thousand pesos (Php 5,000.00) per share and paying for them in either lump sum or in regular installments for two years; if installment: to give initial at least One Thousand Pesos (Php 1,000.00); and I also agree to make additional share capital of at least Php 120.00 per month.
  2. Help build up the capital of Cooperative by opening a savings account with Two Hundred Pesos (Php 200.00) as initial deposit and contribute at least Php 120.00 per month and I also agree to deposit at least fifty percent (50%) of amount that may be due me in the form of interest on capital or patronage refund.
4. To pay the membership fee of Two Hundred pesos (Php 200.00);
5. To comply with the directives of duly constituted authorities as well as decisions of the Board regarding the operating policies of BHIARCo.
The provisions of this agreement, Articles of Cooperation and By-Laws have been explained to me. I understand them and agree to abide with them.

In all of the above undertakings, I am aware that the Board of Directors may impose sanctions against me or perform any acts necessary to make the sanction/s effective without going to court.

In witness hereof, I have affixed my signature/right thumb mark this Day* day of Month* , year 20 Year* .

Printed Name*
Applicant's signature

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Payment Reference Number/OR
Please input your Email/Messenger( You're Share Capital Amortization Schedule and receipt will be send to your Email/Messenger)*
ex. bhiarco@yahoo.com/bhiarco@gmail.com/ name in messenger(bhiarco)
Upload 2x2 Picture

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Upload File(Proof of Payment/Deposit Slip) Thru Bank Transfer(you can you use Paymaya/Gcash for bank Transfer)

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Should be Empty:

MEMBERSHIP APPLICATION FORM

PAYMENT GUIDE THRU BANK TRANSFER

MEMBERSHIP AND SUBSCRIPTION AGREEMENT