This document is a membership form for the Paglaum Multi-Purpose Cooperative. It requests personal information such as name, date of birth, contact details, employment, and income. The form also asks for emergency contact details and educational background. Applicants must sign to certify the accuracy of the provided information. A sponsor is also required to endorse each application.

1. PAGLAUM MULTI-PURPOSE COOPERATIVE
Head Office: 2F Eastern Looc, Plaridel, Misamis Occidental Tel # (088) 344-8633
CDA Reg. No. CGY-976
2X2
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MEMBERSHIP FORM
Date:__________________
1. Name ______________________________________________________________________
(FAMILY NAME) (GIVEN NAME) (MIDDLE NAME)
Date of Birth:_______________ Birth Place:___________ Civil Status:_________
Religion:___________________ Sex:________________ Tribe:______________
SSS/GSIS No.________________ TIN No.____________ Postal Code__________
Address: __________________________________________________________
Business/Office Address:______________________________________________
2. Beneficiary/ies in case of emergency / death:
Spouse:_________________ Birth Date:_________ Contact No.______________
Children:________________ Birth Date:_________ Contact No.______________
_________________ Birth Date:_________ Contact No.______________
_________________ Birth Date:_________ Contact No.______________
Others : ________________ Relationship:________Contact No.______________
_________________ Relationship:________Contact No.______________
3. Educational Attainment: ______________________________________________
4. Present Employment/ Business Activities:___________________________________
OCCUPATION : ( ) Private Employee ( ) Gov’t Employee ( ) Self-Employed ( ) Farmer
( ) Pensioner ( ) Student ( ) Housekeeper ( ) Fisherfolk
( ) Entrepreneur/ Vendor ( ) Others ________________
MONTHLY INCOME: ( ) 0-999 ( ) 2,000-2,999 ( ) 4,000-4,999 ( ) 10,000-15,000
( ) 1,000-1,999 ( ) 3,000-3,999 ( ) 5,000-9,999 ( ) 15,000 +
I hereby certify that the above information is true and correct.
Signed this_____ day of ______________,_______.
________________________________
Signature

2. Endorsed by: ____________________