New Member Registration Form

New Member Registration Form

ATA PRIVACY STATEMENTPay it Forward Marketing Cooperative (PIFMC)Pay it Forward Marketing Cooperative (PIFMC) values your privacy and is committed to protecting your personal information in compliance with the Data Privacy Act of 2012 (R.A. 10173).Your personal data is collected and used only for legitimate cooperative purposes such as membership processing, record keeping, transactions, and compliance with legal requirements. All information is kept secure and accessed only by authorized personnel.
Pre-Membership Education Seminar Certificate*
Pre-Membership Seminar Certificate Control Number*
Proof of Payment if only payment*
Take Photo
PERSONAL INFORMATION
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Place of Birth*
Age*
Nationality*
Religion*
Civil Status*
Gender*
Educational Attainment

ElementaryHigh SchoolCollegeVocationalOthers
Phone Number*
TIN No:
SSS/GSIS No.:
Philhealth No.:
E-mail
example@example.com
FAMILY INFORMATION
Name of Spouse:*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Place of Birth*
Age*
Nationality*
Religion*
Occupation*
Company *
Annual Income*
Phone Number*
E-mail
example@example.com
BENEFICIARIES
PROFESSIONAL INFORMATION
Occupation*
Position*
Years in Service*
Name of Company*
Business Address*
Nature of Business*
Phone Number*
E-mail
example@example.com
Annual Income*
DECLARATION

I hereby apply for membership in the Pay It Forward Marketing Cooperative and agree to obey its rules and regulations as set forth in its By-Laws and Amendments thereof, or resolutions of the General Membership and the Board of Directors. I hereby certify that all information provided above is true and correct.

Further, I commit to:
SUBSCRIPTION AGREEMENT
Subscribed Share Capital*
Note: This is not withdraw-able
Less: Initial Paid Share Capital *
Note: This is not withdraw-able
Subscription Recievable *
Note: This is not withdraw-able
Payable
Referred by (please put member's ID Number)*
Signature

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New Member Registration Form

PERSONAL INFORMATION

FAMILY INFORMATION

PROFESSIONAL INFORMATION

SUBSCRIPTION AGREEMENT