No.

___________

AGDAO MULTI-PURPOSE COOPERATIVE

Head Office: AMPC Green Bldg., Corner Urduja & N. Torres St., Obrero, 8000 Davao City
Tel. Nos.: 300-3828 (telefax); 300-4355; 285-3797; 227-0248; 285-3805

MEMBERSHIP APPLICATION FORM

Branch PMES Certificate Number Date of Application
Recent 1x1
Picture

PERSONAL INFORMATION
LASTNAME FIRSTNAME MIDDLE NAME

Date of Birth (mm/dd/yy) Place of Birth Height Weight

________ ________
Tax ID Number (TIN) SSS Number Other I.D.(specify) ____________________
ID No. _______________

Highest Completed Level of Education No. Of Dependents Ages of Dependents

Present Address
Owned Rented Mortgaged
Others:_________________
Provincial Address (if different from home address) Do you own a vehicle? If yes, pls indicate details:

Type: ___________________ Plate#______________

Length of Time at Present Address Contact Number/s Email Address

EMPLOYMENT/BUSINESS INFORMATION
Occupation Length of Service/Date Started Employer/Business Name

Employer/Business Address Contact Number/s

Which of the following comes closest to your monthly income in Philippine Pesos? Employment Status
Under 8,000 8000-15000 15,001-30,000 Regular/Permanent Others
30,001-50000 50,001-100,000 Above 100,000 Contractual ________
SPOUSE’S INFORMATION
LAST NAME FIRST NAME MIDDLE NAME

Date of Birth Contact Number/s Occupation

Employer/Business Business/Employers’ Address/Contact Number

Monthly Income (In Pesos) Employment Status Length of Service/Date Started

REFERENCES
Name Address Telephone No. Relation
1.
2.
How did you hear about AMPC?
Referred by__________________________ Advertisement (radio, tv, print media) Events/Trade fair
Fliers/Information Drive Internet search/social media Others, pls. specify_____________________

Training Conducted By:

Signature of Applicant

Approved by: Conforme:

Branch Manager/General Manager BOD Res. No./Date

AMPC Membership Form - Revised 2015
HOUSE SKETCH

AMPC Membership Form - Revised 2015

 SUBSCRIPTION AGREEMENT

That I, ______________________________________, of legal age, Filipino, and a resident of

__________________________________________________________, Philippines, do hereby voluntarily attest and declare:

1. That I have voluntarily manifested my intention to be admitted as a member of AGDAO MULTI-PURPOSE

COOPERATIVE (AMPC), a non-agricultural multi-purpose cooperative organized and existing under Philippine laws, registered
pursuant to Republic Act No. 9520, otherwise known as the Philippine Cooperative Code of 2008, under Cooperative
Development Authority (CDA) Registration No. 9520-11005117, with Head Office address at AMPC Green Building, Corner N.
Torres and P. Urduja Extension, Barangay P. Bangoy (formerly, Bo. Obrero), Davao City, Philippines, by complying with the
minimum requirements of membership and submitting all documentary requirements, among others, thereto;

2. That AMPC has made known and explained fully my rights and obligations of membership in this cooperative
as provided by the amended AMPC Articles of Cooperation and Bylaws in relation to Republic Act No. 9520, or the Philippine
Cooperative Code of 2008;

3. That one of my obligations as a member in AMPC is my faithful contribution and/or payment for the minimum
subscribed capital amounting to Fifteen Thousand Pesos (P15,000.00) within the period prescribed by the amended AMPC
Bylaws;

4. That I hereby voluntarily commit to pay fully the total subscription of sixty (60) shares equivalent to Fifteen
Thousand (P15,000.00) Pesos, Philippine currency, within a period of three (3) years from the date of my admission as a
member in AMPC on the basis of Paragraph (b), Section 5, Article II of the amended AMPC Bylaws entitled: “Membership;”

5. That I also undertake to comply with the mandate on continuous capital build-up as provided by Section 3,
Article VII entitled: “Capital Structure” of amended AMPC Bylaws, more particularly on the regular payment of minimum
subscribed share capital. Thus, in addition to my payment of initial share capital amounting to P1,000.00 as one of the
requirements upon admission as a member of AMPC, I voluntarily agree to pay at least the amount of Four Hundred Pesos
(P400) per month, which shall be credited in my share capital in the cooperative within a period of three (3) years or until the said
minimum amount of P15,000.00 shall have been fully paid based on the following schedule of payment: (Kindly check the space
of your choice provided before each item.)

_____a. Lump sum payment of P15,000.00

_____b. The amount of P400.00 monthly
_____c. The amount of P200.00 semi-monthly
_____d. The amount of P1, 200.00 quarterly
_____e. The amount of P2, 400.00 semi-annually
_____f. The amount of P20 daily

6. That I fully understand that my utter failure to pay the said minimum subscribed share capital in the amount of
P15,000.00 within a period of three (3) years affects my membership status in AMPC that is, I will NOT be considered as a
member in good standing and as such, I am NOT entitled to vote therein.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of _______________________, 201_ at
Davao City, Philippines.

_________________________________________
(Printed name and Signature)

AMPC Membership Form - Revised 2015

 SUBSCRIPTION AGREEMENT

That I, ______________________________________, of legal age, Filipino, and a resident of

__________________________________________________________, Philippines, do hereby voluntarily attest and declare:

1. That I have voluntarily manifested my intention to be admitted as a member of AGDAO MULTI-PURPOSE

COOPERATIVE (AMPC), a non-agricultural multi-purpose cooperative organized and existing under Philippine laws, registered
pursuant to Republic Act No. 9520, otherwise known as the Philippine Cooperative Code of 2008, under Cooperative
Development Authority (CDA) Registration No. 9520-11005117, with Head Office address at AMPC Green Building, Corner N.
Torres and P. Urduja Extension, Barangay P. Bangoy (formerly, Bo. Obrero), Davao City, Philippines, by complying with the
minimum requirements of membership and submitting all documentary requirements, among others, thereto;

2. That AMPC has made known and explained fully my rights and obligations of membership in this cooperative
as provided by the amended AMPC Articles of Cooperation and Bylaws in relation to Republic Act No. 9520, or the Philippine
Cooperative Code of 2008;

3. That one of my obligations as a member in AMPC is my faithful contribution and/or payment for the minimum
subscribed capital amounting to Fifteen Thousand Pesos (P15,000.00) within the period prescribed by the amended AMPC
Bylaws;

4. That I hereby voluntarily commit to pay fully the total subscription of sixty (60) shares equivalent to Fifteen
Thousand (P15,000.00) Pesos, Philippine currency, within a period of three (3) years from the date of my admission as a
member in AMPC on the basis of Paragraph (b), Section 5, Article II of the amended AMPC Bylaws entitled: “Membership;”

5. That I also undertake to comply with the mandate on continuous capital build-up as provided by Section 3,
Article VII entitled: “Capital Structure” of amended AMPC Bylaws. Thus, in addition to my payment of initial share capital of
P1,000.00 as one of the requirements upon admission as a member of AMPC, I voluntarily agree to pay at least the amount of
One Hundred Pesos (P100) per month, which shall be credited in my share capital in the cooperative until the said minimum
amount of P15,000.00 shall have been fully paid based on the following schedule of payment: (Kindly check the space of your
choice provided before each item.)

_____a. Lump sum payment of P15,000.00

_____b. The amount of P100.00 monthly
_____c. The amount of P300.00 quarterly
_____d. The amount of P600.00 semi-annually
_____e. The amount of P1,200 annually

6. That in addition to P15, 000, I shall continue to invest in the share capital of the cooperative.
7. That I fully understand that the due and unpaid subscribed share capital shall be subject to fine of two percent
(2%) as determined by Board of Directors for every month of delinquency.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of _______________________, 20____ at
Davao City, Philippines.

_________________________________________
(Printed name and Signature)
Please do not fill below this line
---------------------------------------------------------------------------------------------------------------------------------- --------------------------------

No. Of Shares Paid

Amount Paid
No. Of Shares Subscribed
Amount of Shares Subscribed
Balance

Checked by: Date:

______________________________ _______________________________

AMPC Membership Form - Revised 2015