Annex B

APPLICATION/ACCREDITATION FORM

Name of Organization :
Registered Address :
Contact Nos. :
Date Organized :
Date Registered: (if applicable)
Registering or Accrediting Agency: (Check appropriate box)
□ Securities and Exchange Commission
□ Cooperatives Development Authority
□ Department of Labor and Employment
□ Department of Social Welfare and Development
□ Department of Health
□ Department of Agriculture
□ Department of Agrarian Reform
□ Department of Education
□ National Anti·Poverty Commission
□ National Commission on Indigenous Peoples
□ National Housing Authority
□ Insurance Commission
□ Philippine Regulatory Commission
□ Housing and Land Use Regulatory Board
□ Others: (Please specify)

Purposes/Objectives of the Organization: (Use of additional sheets, if necessary)

_____________________________________________________________________________
________________________________________________________________________________________

Organization's Project, if any: (indicate status and year of implementation, cost, beneficiaries and other
details)
______________________________________________________________________
_________________________________________________________________________________________

Services that the Organization provides:

Name of Officers and Members of the Organization and their respective position: (you may
use separate sheet)
____________________________________________________________________________
____________________________________________________________________

WE HEREBY CERTIFY to the correctness of the above information.

Secretary

Head/ President