APPLICATION FOR LEGITIMATE MEMBER MORTUARY SYSTEM APPLICATION FOR LEGITIMATE MEMBER MORTUARY SYSTEM

(LEMOS) (LEMOS)
The undersigned hereby applies for membership to the Legitimate Member Mortuary The undersigned hereby applies for membership to the Legitimate Member Mortuary
System in accordance with the terms and conditions set forth below.
I. PERSONAL INFORMATION (Please and DO NOT use abbreviation and answer all items) I. PERSONAL INFORMATION (Please and DO NOT use abbreviation and answer all items)

FIRST NAME LAST NAME MIDDLE NAME SEX ( ) Male FIRST NAME LAST NAME MIDDLE NAME SEX ( ) Male
( ) Female ( ) Female

Date of Birth Age: Civil Status Date of Birth Age: Civil Status

Present Address: Contact No. / Email Add: Occupation: Present Address: Contact No. / Email Add: Occupation:

Employer: Employer:

Office Address: Religion: No. of Dependents: Office Address: Religion: No. of Dependents:

Name of Spouse: Name of Spouse:

Person to claim the benefits (In order of preference) Person to claim the benefits (In order of preference)
Name Age Address Relationship Name Age Address Relationship

1 _________________________ _______ _____________________________ __________________ 1 _________________________ _______ _____________________________ __________________

2 _________________________ _______ _____________________________ __________________ 2 _________________________ _______ _____________________________ __________________

3 _________________________ _______ ______________________________ __________________ 3 _________________________ _______ ______________________________ __________________

I hereby certify that the above –stated information is true, complete and correct. I do hereby I hereby certify that the above –stated information is true, complete and correct. I do hereby
agree to the following guidelines: agree to the following guidelines:

1. I am regular member of Barbaza Multi-purpose Cooperative,
2. I am paying a registration fee of P250.00 and this amount is not refundable in case I with-
draw from membership;
3. Benefit claim will be made upon submission of the death certificate,
4. The amount of Benefit claim will be based on my tenure of membership to LEMOS as follows:
Below 1 year ----------------------------- Php 6,500.00
1 year but less than 3 years --------- Php 7,500.00
3 years but less than 5 years -------- Php 10,000.00
5 years and above ----------------------Php 15,000.00
1. I am regular member of Barbaza Multi-purpose Cooperative,
2. I am paying a registration fee of P250.00 and this amount is not refundable in case I with-
draw from membership;
3. Benefit claim will be made upon submission of the death certificate,
4. The amount of Benefit claim will be based on my tenure of membership to LEMOS as follows:
Below 1 year ----------------------------- Php 6,500.00
1 year but less than 3 years --------- Php 7,500.00
3 years but less than 5 years -------- Php 10,000.00
5 years and above ----------------------Php 15,000.00

____________________________ ____________________________
Signature of Applicant Signature of Applicant

APPROVED: APPROVED:

__________________________________ _____________________ __________________________________ _____________________

Approving Authority Date Approving Authority Date