BAUG CARP BENEFICIARIES MULTI PURPOSE COOPERATIVE

Ojeda Avenue, Poblacion 9, Cabadbaran City

CDA Registry Number 9520-13001993
Telephone No. (085) 818 5421
Email add: baugcoop@gmail.com,

APPLICATION FOR MEMBERSHIP

____________________________
Date of Application
BAUG CARP BENEFICIARIES
MULTI PURPOSE COOPERATIVE
_____________________________[branch Address]
_____________________________[branch Address]

Board of Directors:

I hereby apply to membership in Baug CARP Beneficiaries Multi Purpose Cooperative (BCBMPC)
and agree to obey faithfully its rules and regulations as set down in its Articles of Cooperation and By-Laws,
and amendments thereof, the decisions of the General Assembly and those of the Board of Directors.

I HEREBY AGREE:
1. To pay the amount of Php 1,800.00 Photo ID
Enclosed in Php 1,800.00 are as follows:
Membership Fee -------------- Php 500.00
Initial Share Capital -------------- Php 200.00 1PC 1X1 PICTURE
Mortuary Fund -------------- Php 500.00 OR
Coop Passbook -------------- Php 40.00 1PC 2X2 PICTURE
Annual Dues -------------- Php 60.00
Initial Savings Deposit ------------ Php 500.00
TOTAL Php 1,800.00
2. To develop within the habit of thriftiness by savings at least Php ____________ to my savings account.
3. To comply with the directives of duly constituted authorities as well as the decisions of the Board of
Directors regarding the operating policies of BCBMPC.
4. To subscribed to at least Fifty (50) Common Share Capital at P100.00 par value or equivalent to
P 5,000.00 to complete the required minimum number of shares for a full-pledge member within a
period of not more than Two (2) years from the dated my application for membership has been
approved.
_________________________________________
Signature of Applicant over Printed Name

IN CASE IF WITHDRAWAL OF MEMBERSHIP:

1. Membership Fee and Mortuary Benefits Premium are NON-REFUNDABLE.
2. A withdrawal fee of P50.00 of the Share Capital withdrawn shall be charge.

MEMBERSHIP IN OTHER COOPERATIVE:

Name(s) of Cooperative Active/Not Active

In witness hereof; I have hereunto affixed my signature this _______ day of _____________________, 20______.

Recommended by:

_____________________________________ ___________________________________________
Signature over Printed Name Signature of Applicant over Printed Name

REMINDERS: DO NOT PAY TO AGENTS

 Pay directly to the Cashier/Teller
 For every PAYMENT you make, demand of an OFFICIAL RECEIPT

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 PERSONAL INFORMATION
Last Name First Name Middle Name Nickname

Home Address: Place of Birth:

__________________________________________________ _____________________________________

Nationality: _____________ Height: _______ Weight: ________ Blood Type: _____ Occupation: _______________
Gender: Male Female Birthday: _________________ Civil Status: _______________ Age: ________
SSS No.: _________________________ TIN No.: _______________________ Telephone No.: ______________________
Mailing Address: ______________________________________________________ Monthly Salary: _________________
Name of Spouse: _________________________________ Occupation: ____________ No. Of Dependents: ______

EMPLOYMENT RECORD
Name of Company: ______________________________ Position: ___________________ No. Of Yrs. Worked: _____
Company Address: ______________________________________________ Company Tel. No: ___________________
Spouse Employment Record:
Name of Company: ______________________________ Position: ___________________ No. Of Yrs. Worked: _____
Company Address: ______________________________________________ Company Tel. No: ___________________

EDUCATIONAL ATTAINMENT
Name of School: ___________________________________________________________ Year Graduated: _________
Level: Elementary High School Vocational College Post Graduate

REFERENCES
Name Address Relationship Tel. No.
1. ________________________________ ______________________________ ___________________ ______________
2. ________________________________ ______________________________ ___________________ ______________
3. ________________________________ ______________________________ ___________________ ______________

PHOTO

_______________________________
Draw the sketch of your residence inside the box Membership Signature

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 MORTUARY FUND MEMBERSHIP

____________________
DATE APPLIED

NAME: ________________________________________________________ AGE: ______________

SEX: _______________ STATUS: SINGLE MARRIED SEPARATED WIDOW

ADDRESS: _____________________________________________ NATIONALITY: _______________

PRIMARY BENEFCIARY:

NAME: ____________________________________ AGE: __________ RELATIONSHIP: ___________

SECONDARY BENEFICIARIES:

1. ____________________________________________________________________

2. ____________________________________________________________________

3. ____________________________________________________________________

4. ____________________________________________________________________

In connection with my membership application with your cooperative, I hereby authorize

BCBMPC to obtain such information as may require concerning this application and agree
that such information shall remain as the cooperative’s property whether or not my application
is considered.
I hereby certify that the foregoing information and date are true and correct and agree
to notify the cooperative of any change affecting my membership based on the information
contain herein.
Done this _______ day of __________________, 20____ , Magallanes Agusan del Norte,
Philippines.

__________________________
NAME AND SIGNATURE

APPROVED BY:

__________________________ _________________________
MANAGER/CHAIRMAN DATE APPROVED

PLEASE READ & SIGN THE MORTUARY POLICY AT THE NEXT PAGE.

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 MORTUARY FUND POLICY
1. Membership fee of P 500.00 shall be collected from the coop members upon acceptance
and approval of application.
2. For death due to natural cause (sickness/illness) and accident mortuary aid shall be as
follows:

For Members of the cooperative more than 6 months

Benefit Benefit
Benefit
Coverage 60 years old 70 years old
61 to 69 years old
& below & above
Member P 30,000.00 P 15,000.00 P 7,500.00
(+ Incentive based on CBU)
Spouse P 10,000.00 P 5,000.00 P 2,500.00
Beneficiaries P 5,000.00 / P 2,500.00 / P 1,250.00 /
(entitled to 2 dependents) Dependent Dependent Dependent

 Additional incentives of P 5,000.00 to those members with

CBU of P 10,000.00 – P 24,999.99
 Additional incentives of P 10,000.00 to those members with
CBU of P 25,000.00 and above.
 In case of loan balance, if insurance could not offset its account, mortuary benefits
will be deducted and balance thereof will be given to the immediate beneficiary.

3. Mortuary shall be released as soon as the confirmation of officer of the cooperative by

submitting necessary documents:
a) Submission of Original or Certified True Copy Death Certificate
b) Submission of Marriage Contract (if married)
c) Submission of Birth Certificate (if the claimant is the beneficiary)
d) Authorized representative for claiming the fund.
Surviving spouse/Primary claimant/Secondary claimant

4. Yearly payment of P 500.00 must be done every first quarter of the year (Jan. – Mar.)
If the member fails to pay the said yearly payment the coop has the option to:
 Automatically deduct from the dividend and patronage refund of the member;

5. For New and Returning Members whose age are above 60 years old;
starting January 1, 2023;
 Insurance premium is P600.00 per annum.
 A contestability period of 1 year will be applied, in case of death of the member/s, their
spouse/s and beneficiaries within the contestability period, the claimant will not receive
any benefits from the cooperative

6. Member of Non-continues mortuary fund payment will undergo 1-year contestability

period from the time of repayment.

7. Account must be settled first, before any release of mortuary benefit.

___________________________________
CONFORME

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DATA PRIVACY NOTICE

In compliance with Republic Act No. 10173 or the Data Privacy Act of 2012 (DPA), its Implementing Rules and Regulations, and
other relevant policies, including issuances of the National Privacy Commission. Baug CARP Beneficiaries Multi Purpose
Cooperative (BCBMPC) respects and valued the member’s data privacy rights, and makes sure that all personal data collected
from our members and clients, are processed in adherence to the general principles of transparency, legitimate purpose, and
proportionality.

BCBMPC commits to abide the Data Privacy Law in order to retain the trust and confidence of our members and clients. Oath to
safeguards personal data information of data subjects within the cooperative.

i. The cooperative collects the basic information of members, clients and customers, including their full name, address, email
address, contact number, and other personal information in application of membership and/or availing product services.
The representative attending to client/customers will collect such information through accomplished forms.
ii. Personal data collected shall be used by the cooperative for documentation purposes, for warranty tracking in relation to
the availed items, and for the inventory of products.
iii. This cooperative will implement appropriate security measures in storing collected personal information, depending on the
nature of the information.
iv. All personal information of members/client will be retained perpetually electronically. All other information gathered in
hardcopies shall not be retained for a period longer than five (5) year, shall be disposed and destroyed, through secured
means.
v. Only the member/client and the authorized representative of the cooperative shall be allowed the access of such personal
data, for any purpose, except for those contrary to law, public policy, public order or morals.
vi. Personal data under the custody of the cooperative shall be disclosed only pursuant to a lawful purpose, and to authorized
recipients of such data.
vii. For data privacy concerns, contact BCBMPC Data Privacy Officer at dpo@bcbmpc.com

DATA PRIVACY CONSENT

In compliance with the Data Privacy Act (DPA) of 2012, and its Implementing Rules and Regulations (IRR) effective since
September 8, 2016, I allow Baug CARP Beneficiaries Multi Purpose Cooperative (BCBMPC) to provide me certain services
declared in relation to the product I availed.

As such, I agree and authorize BCBMPC to:

 Keep my personal data information in their system perpetually. An official letter will be given to Cooperative in case of
personal data deletion request.
 Share my credit information as mandated by law (CISA) to Credit Information Corporation (CIC).
 Share my personal data information in compliance to government agencies such as CDA, DAR and other entities as
mandated by law.
 Share my information to affiliates and necessary third parties for any legitimate business purpose. I am assured that my
data information will not be compromised and will be protected.
 Inform me of future customer campaigns and base its offer using the personal information I shared with the cooperative.

I also acknowledge and warrant that I have acquired the consent from all parties relevant to this consent and hold free and
harmless and indemnify BCBMPC from any complaint, suit, or damages which any party may file or claim in relation to my
consent.

Signature over Printed Name

Date:

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