Birhen ng Bayang San Mateo Multi-Purpose Cooperative

(BBSAMAMUCO)

#36 M.H. Del Pilar St., Guitnang Bayan 1, San Mateo, Rizal

 Contact Nos.8650-5260; 0917-8523176; 09194585993

bbsamamuco@gmail.com www.bbsamamuco.com; @BBSAMAMUCOOPERATIVE

I hereby apply for membership in your cooperative after having fully satisfied the following requirements provided by the rules governing such application

That, I have attended the Pre-Membership Education Seminar (PMES) held on and venue at

 In this connection, I hereby attest to the truth of the following information

Further, I attest to the following:

1. that, I understand that this application shall be a accompanied by a membership fee of One Hundred Pesos (Php100.00) and referral fee of One Hundred Pesos (Php100.00);

2. that, I shall subscribe to at least forty (40) shares with a total value of Two Thousand Pesos (Php2,000.00) of which, at least Five Hundred Pesos (Php500.00) corresponding to ten (10) shares shall be paid upon being accepted as member. I promise to pay the balance of thirty (30) shares with a total value of One Thousand Five Hundred Pesos (Php1,500.00)

3. that, if qualified and accepted as member, I pledge to undertake the responsibilities of being a member as provided for in the by-laws, such as: - patronize regularly its business and attend the membership meeting, regular or special; - adhere to the retention of 2% to 1% for every loan I made, if applicable; and - contribute my annual interest on share capital to my Share Capital.

I declare the information given by me in this form to be true and correct. I further agree to notify Birhen ng Bayang San Mateo Multi Purpose Cooperative in writing in case of any change in my personal information.