Secured Access for Free Enterprise (S.A.F.E.) Cooperative

MEMBERSHIP APPLICATION FORM

PERSONAL INFORMATION

Last Name

First Name

Middle Name

Date of Birth

Gender

Male

Female

Civil Status

Single

Married

Widowed

Seperated

Nationality

Religion

Contact Number

Email Address

Present Address

Permanent Address (if different)

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Primary Valid ID Type

EMPLOYMENT / BUSINESS INFORMATION

Occupation / Position

Employer / Business Name

Employer / Business Address

Monthly Income

Below ₱ 10 000

₱ 10 000 - ₱ 20 000

₱ 20 001 - ₱ 50 000

₱ 50 001 & above

MEMBERSHIP DETAILS

Type of Membership

Regular

Share Capital Subscription: Minimum number of 108 Shares (100 pesos per share)

₱10800 and ₱1000 Membership Fee (Non Refundable)

Mode of Payment:

Cash

Bank Transfer

BENEFICIARIES:

FULL NAME (Example: Juan A. Dela Cruz)	RELATIONSHIP (Primary)	CONTACT NUMBER (Example: 09051234567)
Input Full Name #1	Select One	Input Contact Number
Input Full Name #2	Select One	Input Contact Number
Input Full Name #3	Select One	Input Contact Number

DECLARATION AND CONSENT

I hereby certify that the above information is true, correct, and complete. I declare that this Membership Application Form has been accomplished by the undersigned in accordance with the pertinent laws, rules, and regulations of the Republic of the Philippines. I agree to abide by the rules and regulations of the cooperative and authorize the Secured Access for Free Enterprise (S.A.F.E.) Cooperative to collect, process, verify, and validate my personal data in accordance with the Data Privacy Act of 2012.

SUBSCRIPTION AGREEMENT

I, of legal age, and a resident of the above-mentioned present address, do hereby voluntarily subscribe to the capital of Secured Access for Free Enterprise (S.A.F.E.) Cooperative, a duly registered cooperative under the laws of the Republic of the Philippines, with CDA Registration No. 9520-100300036546. In this regard, I agree to the following terms and conditions:

1. Share Subscription - I hereby pledge and commit to subscribe to the minimum number of shares as prescribed under the Capital Build-Up Policy of the cooperative, in accordance with its By-laws, relevant policies, and SAFECOOP’s capital build-up policy.

2. Payment Terms - I undertake to pay my subscribed capital shares in accordance with the schedule and terms set by the cooperative.

3. Continuous Capital Build-Up - I agree to participate in the cooperative’s continuous capital build-up program, as may be required under its policies.

4. Membership Standing - I understand that failure to fully pay my subscribed shares within the prescribed period may affect my membership status, including my rights and privileges as a member, and voting rights, in accordance with the cooperative’s By-laws and applicable laws.

5. Compliance - I commit to abide by the Articles of Cooperation, By-laws, and all duly approved rules, regulations, and policies of the cooperative, as well as relevant laws, rules, and issuances of the Cooperative Development Authority (CDA) and other regulatory agencies.

IN WITNESS WHEREOF, I have affixed my signature on this day:

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FOR COOPERATIVE USE ONLY (PLEASE DO NOT FILL UP BELOW THIS LINE)

MEMBERSHIP APPLICATION FORM RECEIVED BY:

Name

Position

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MEMBERSHIP APPLICATION APPROVED BY:

Name

Position

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