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MEMBER INFORMATION SHEET photo here

System ID # ______________
Member’s Category: () Non-Revenue ( ) Revenue-Absorbed ( ) Revenue-Sourced ( ) Re-assignment ( ) Seasonal
PERSONAL INFORMATION
Member’s Nickname: Date of Birth: mm/dd/yyyy
Last Name First Name Middle Name Occupation

MEMBER’S NAME: Place of Birth:

FATHER’S NAME: Gender: () Male

() Female
MOTHER’S NAME: Age: ____
(Maiden Name) Blood type: ____
SPOUSE’S NAME
(If Married)
Height: ___
Weight___kg.
No. of Dependents: Civil Status: SSS :
Landline No.
Email: Mobile No: PAGIBIG:
Address: PHILHEALTH:
TIN:
IN CASE OF EMERGENCY PLEASE CONTACT
Name:
Address:
Relationship: Contact No.:
EDUCATIONAL BACKGROUND
Degree Name of School From Date To Date Course Taken
Elementary
High School
College
Postgraduate/others
WORK EXPERIENCE (start from the latest/current)
Name of Company Address of Company Position Held From Date To Date Reason for Leaving

REFERENCES (NOT RELATED TO YOU)

Name Company Name Position Contact Number

I hereby certify that the above information given, and all statement made herein are true and correct.
________________________________________
Signature over printed name / Date
Please sketch your present address
 APPLICATION FOR ASSOCIATE MEMBERSHIP

LAST NAME FIRST NAME MIDDLE NAME

I hereby apply for Associate Membership with KINGS COOPERATIVE. If accepted as member, I agree faithfully abide by
the Cooperative’s Articles of Cooperation and By-Laws, and its rules and regulations as well as by the decisions of the
members in the General Assembly and those of the Board of Directors.

I also pledge to:

1. Attend and finish the prescribed Membership Orientation Program (MOP).

2. Pay the required one-time, non-refundable membership fee of Php 2,000.00.
3. Subscribe to at least One Hundred (100) preferred shares (share capital) valued at Php1.00 per share or
equivalent to Php100.00.
4. Put-up the required Member’s Fund (Continuous Deduction)
5. Contribute to revolving capital, for the purpose of funding Kings Cooperative business expansion through
deduction from my share in the service surplus and/or deferral of at least 50% of my interest in the share capital
(dividends) and patronage refund.
6. Participate in Kings Cooperative savings program.
7. To contribute my personal work, in the form of professional services in any of the Kings Cooperative contract
projects or businesses. My share in the services surplus and duration of service shall be agreed upon mutually
depending on the project requirements.
8. Participate in all the training programs of Kings Cooperative; and
9. Acknowledge and recognize that in the event that I, as a self –employed individual, qualify as member, it shall
not establish any employer-employee relationship between Kings Cooperative and I, nor between I and/or any
client of Kings Cooperative where I will be assigned, as I recognize that the voluntary professional service I am
rendering, forms part of my contribution as a member of Kings Cooperative, a duly registered worker’s
cooperative operating pursuant to the provisions of article 23(t), of R.A. 9520 and that the relationships
established herein are being governed not by the Labor Code of the Philippines and its related laws but by the
Philippine Cooperative Code of 2008 (R.A. 9520) and its allied laws.

I warrant that I am not an employee of any company and have voluntarily resigned and was cleared of any liability/obligation
from my previous employer/principal, if any. That, any misinterpretation and/or violation of the aforementioned
pledges/warranty shall be a ground for the immediate termination of my membership from the Cooperative.

AUTHORIZATION

I hereby authorize the Cooperative, as my irrevocable agent to deduct from my gross share in the service surplus the following:

1. Up to 10% for at the amortization of my share capital and Member’s Fund until fully paid as a member of Kings
Cooperative.
2. The appropriate amounts for my SSS, PAG-IBIG and PHILHEALTH contributions, and whenever applicable,
and withholding tax, and to remit the same to the government agency(ies) concerned.
3. 1% for my contribution in revolving capital/fund for business expansion.
4. At least Php 25.00 per month as my savings deposit.

In the case of cessation of membership (payment of capital contributions, deposits, revolving capital and earnings):
I understand that in case of cessation of my membership, for any cause, my paid-up capital contribution, member’s fund,
deposits, revolving capital and earnings, if any, due to me, minus my obligation to Kings Cooperative shall be paid to me
subject to fund availability, Cooperative reserve requirements, provisions under the Cooperative’s articles and by-laws, and
applicable laws, covering cooperatives.

_____________________________________________ ______________________
SIGNATURE OF APPLICANT FOR MEMBERSHIP DATE

OTHER SOURCE(S) OF INCOME: No. of Dependents:

Beneficiary(ies)
Name Age Relationship
1
2
3

For Kings Cooperative only:

NBI/Police Clearance Birth certificate Resume/Biodata
Barangay Clearance Marriage Contract Member Information Sheet
SSS and Philhealth photocopy Birth Certificate(s) of child(ren) Others: ________________________
Medical Certificate