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Cso Documents

This 3 page document is an application form for civil society organizations (CSOs) seeking accreditation from the Philippine Department of Agriculture (DA). The form requests information about the CSO's basic details, previous accreditation status, contact information, purposes for organizing, intended beneficiaries, geographic scope, requested public funds, social issues to be addressed, and authorization for the DA to validate the application. It also includes a bio data form for representatives. Upon completion, the authorized representative must sign to certify the accuracy of the information provided.

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Catherine Sagun
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52 views

Cso Documents

This 3 page document is an application form for civil society organizations (CSOs) seeking accreditation from the Philippine Department of Agriculture (DA). The form requests information about the CSO's basic details, previous accreditation status, contact information, purposes for organizing, intended beneficiaries, geographic scope, requested public funds, social issues to be addressed, and authorization for the DA to validate the application. It also includes a bio data form for representatives. Upon completion, the authorized representative must sign to certify the accuracy of the information provided.

Uploaded by

Catherine Sagun
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF AGRICULTURE

APPLICATION FORM FOR ACCREDITATION OF CIVIL SOCIETY ORGANIZATION/S (CSO)

Information on previous DA CSO Accreditation if applicable


Status / New Applicant
For Renewal

Previous DA CSO
Accreditation No.
Date Issued

Date of Expiration

Accreditation Level National


Regional
/

Category Co-implementer
Beneficiary
/

BASIC INFORMATION:

Complete name of CSO


(as stated/indicated on the registration papers)
Other Name
(e.g., acronym, short name, previous name, etc.)
No. and Street
Barangay
Principal address or
place where the CSO Municipality
operates as a group Province
Zipcode
Name
Head of CSO
Position/Designation
Landline No.
Mobile No.
Contact Details
Email Address
Website
Name
Coordinator/Staff-
Position/Designation
in- Charge of Branch
or Satellite Office/s
if there is any Contact Number

Purposes or reasons for organizing or forming


as a group
Government Agencies (Gas) from which the
CSO expects to receive public funds
Estimated amount of public funds to be
requested from the Gas

SOCIAL PREPARATION: (USE ADDITIONAL SHEET IF NECESSARY)


Social Issue/Problem Description of Geographical Location Beneficiary Sector/s:
Program/Project (pls. indicate specific Barangay,City/ (Fisher folks, Farmers, Persons with
Municipality, Province and Region) Disabilities, Children, IndigenousPeople,
Older Persons, Cooperative members,
mixed group, etc.)

DA-CSO APPLICATION FORM / BENEFICIARY CSO


AUTHORIZATION:

On behalf of the CSO Applicant, I hereby:


(a) Authorize the DA to inspect the premises of the office(s) of the CSO Applicant, as well as the
site of any past or present project or program of the CSO Applicant, and
(b) Authorize any concerned person to disclose the DA any fact material to the validation of any
information provided by the CSO Applicant in this application or in any of the documents
submitted in support thereof.

AFFIANT- Authorized Signature


Representative Name
Position/Designation
Date executed
Place executed

SUBSCRIBED AND SWORN to before me, on the above date and place, affiant exhibiting the
following identification document:
Government ID type and No.
Place and date of issue
Valid until

Doc. No. Signature


Name of Notary
Page No.
Public
Book No. Address
Commission valid
Series of
until
DA-CSO APPLICATION FORM
BIO DATA PICTURE

Personal Information

Name
Position in the Board
Home Address
Date of Birth
Contact Number
Email Address
Nationality

Educational Attainment

Employment Record
1. Position
Employer
Dates
Duties

2. Position
Employer
Dates
Duties

CERTIFICATION

I, the undersigned, certify certify that these data are true and correct

Signature
Date

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