Membership and Subscription Agreement Form

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
Spouse/Child/Parent
Date of Birth

MonthDayYear
Date
Contact No.
Beneficiary 2
Name M.I. Surname
Relationship
Spouse/Child/Parent
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)
Relationship
Spouse/Child/Parent
Dependent 2
Dependent2. Name M.I. Surname
Dependent 2. Date of Birth

MonthDayYear
Date
Contact No.(Dependent 2)
Relationship
Spouse/Child/Parent

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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Data Privacy Statement: The Member hereby agrees and authorizes NATCCO MICOOP-BHIARCO to use all pertinent data and information provided for, solely for the purpose of the Compliance Audit and in consonance with data Privacy Act of the Philippines or RA 10713 and Data Privacy of NATCCO. Or you visit the link for more info: https://www.natcco.coop/privacy-policy

AGREE

MEMBERSHIP AND SUBSCRIPTION AGREEMENT
The BOARD OF DIRECTORS:
Bayanihan Hundred Islands Agrarian Reform Cooperative
L. De Castro St., Poblacion Alaminos City, Pangasinan

Ladies / Gentlemen:
I, a resident of ,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) share and paying for them in either lump sum or in regular installments for two years; if installment: to give initial at least One Hundred Pesos (Php 100.00); 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.
  3. Fine of P1,000.00 for not subscribing the five thousand pesos (Php 5,000.00) share capital within two years.
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 20Year* .

Printed Name*
Applicant's signature

Clear
Payment Reference Number/INVOICE No.
Birth Certificate and/or Marriage Certificate if married

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MEMBERSHIP APPLICATION FORM

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MEMBERSHIP AND SUBSCRIPTION AGREEMENT