• NICO Membership Application

  • Welcome to NICO’s Membership Application Form!


    Thank you for your interest in becoming part of our cooperative.
    Please complete the form fully and accurately.

    To begin, simply choose the branch you wish to register with by clicking the branch options provided — this will help us process your application and connect you to your chosen branch.

    If you have any questions, feel free to contact the branch directly or call our hotline at 0919-818-2188.

    Let’s get started — we look forward to welcoming you as a NICO member!

  • APPLICATION FOR MEMBERSHIP

  • Date Filed
     / /
    2 digit month, 2 digit day, 4 digit year

  • I agree to faithfully and willingly

    • Obey the rules and regulations embodied in the Articles of the Cooperative and By-Laws of the associates, the decision of the General Assembly and those to the Board of Directors;
    • Attend Ownership meetings, seminars and trainings;
    • Participate in the savings program of the cooperative and other services and programs which the cooperative may offer;
    • Pay the membership fee of Two Hundred Pesos (P200.00
    • Contribute at least P125.00 per month for continuous Capital Build-up; and
    • Contribute at least% of the interest on capital and patronage refund due to me.

    I further agree to faithfully and willingly comply with the following Membership Subscription agreement:

    • Subscription of at least 40 shares of common stock.
    • Payment of at least P1,000.00 of the common stock subscribed.
    • Payment of the unpaid subscription (if any) within three (3) years.
    • Payment of two (2) percent interest per month of delinquency based on the unpaid subscription after the prescribed payment period of three (3) years.

  • CLIENT PROFILE

  • BIRTHDATE
     / /
    2 digit month, 2 digit day, 4 digit year
  • Mailing Address
  • Type of Address
  • Are you an IP?

  • Business/Employer Information/Occupation/Source of Income Business/Employer Name

  • Are you a farmer or farm owner?

  • Education

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Contacts and IDs

  • Format: (000) 000-0000.

  • Spouse Information

  • Date of Birth
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date Hired
     / /
    2 digit month, 2 digit day, 4 digit year

  • Beneficiares and References

  • Beneficiary 1

  • Birthdate
     - -
    2 digit month, 2 digit day, 4 digit year

  • Beneficiary 2

  • Birthdate
     - -
    2 digit month, 2 digit day, 4 digit year

  • Beneficiary 3

  • Birthdate
     - -
    2 digit month, 2 digit day, 4 digit year

  • Character Reference 1

  • Format: (000) 000-0000.

  • Character Reference 2

  • Format: (000) 000-0000.

  • Other Information (For Farmers)

  • Techniques
  • Technolgy usage
  • Market
  • Purpose
  • No. of workers

  • NICO HEALTH SAVER APPLICATION FORM

  • 1. Open to all regular and associate members. Age( -69)

    2. Minimum deposit of P6, 000.00 and maximum of P30, 000.00 per annum.

    3. Interest rate of 6% per annum compounded annually and will be accumulated only on payment of full year premium.

    4. Premature withdrawals permitted subject to :

    a. Health emergencies -Self or immediate family member

    b. Health Saver Insurance Premium Payment.

    C. 100% withdrawal permitted; however, minimum balance of P1000 to be maintained for account to stay active.

    5. Withdrawals for non-health reason is not permitted, as this plan is for protection during a health emergency, however if member insists, the plan will be terminated and will only bear an interest of 2%

    6. After 5 years, member may withdraw the total accumulated balance or transfer the amount to a new

    7. Member needs to pay the pledged amount every year. Non-payment will result in

    a. Termination of Health Saver plan, and interest for plan will be reduced to 2%

    b. Please note that the pledged amount needs to be deposited every year regardless of

    8. Requirement to be submitted for withdrawal of savings:

    Doctor's prescription/ Receipts/ Medical Certificate/ hospital bills

    9. Bundled insurance of Hospital Income Benefit.

    a. Hospitalization Income Benefit -(Member and nominated family member 1)P500 * 10 days / policy year

    b. Hospitalization Income Benefit -(Nominated family member2) P250*10 /policy year C. Premium - P 500 / annum

    d. First year insurance to be paid by member, second year member can pay additionally or will be deducted from Health Saver deposit by NICO and paid as insurance premium.

    e. Contestability period: 15 days for natural illness, 3 months for pre-existing

    I hereby acknowledge that I have read, understood and agree to the terms of the NICO Health Saver. I also authorize NICO to deduct P500 towards Health Saver Insurance Premium.

     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     

  • Pledged Amount - Between 500 to 2,500 per month

  • Payment Mode
  • Date Of Birth
     / /
    2 digit month, 2 digit day, 4 digit year
  • Gender
  • Date Of Birth
     / /
    2 digit month, 2 digit day, 4 digit year
  • Gender

  • PLANHOLDER/PRINCIPAL DEPOSITOR'S NAME:

  • Co-Assured Dependents/Immediate family members: SPOUSE (if Planholder is Married) 

     
  • Birthdate
     - -
    2 digit month, 2 digit day, 4 digit year

  • One (1) ADDITIONAL Co-ASSURED (Child, if Planholder is married; Parent/Sibling, if Planholder is single)

     
  • Birthdate
     - -
    2 digit month, 2 digit day, 4 digit year

  • Requirements & Proof of Payment

    Please upload clear photos or scanned copies of the following documents. All uploaded files will be securely stored for verification.

    • 2x2 ID Picture

    • Proof of Civil Status(Birth Certicate is single or marriage contract is married)              
    • 1 Valid ID (Government-issue)
    • TIN(Tax Identification Number) 
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
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