MEMBERSHIP APPLICATION

MEMBER'S PERSONAL DATA

LAST NAME *

FIRST NAME *

MIDDLE NAME *

DATE OF BIRTH *

PLACE OF BIRTH *

RELIGION *

AGE *

GENDER *

Male

Female

HEIGHT *

WEIGHT *

ADDRESS *

ZIP CODE *

EMAIL *

CONTACT NUMBER *

TAX IDENTIFICATION NUMBER *

CIVIL STATUS *

Single

Married

Separated

Widowed

VALID/GOVERNMENT ISSUED ID's

ID TYPE *

ID NUMBER *

IF SELF-EMPLOYED

BUSINESSS NAME *

CONTACT NUMBER *

BUSINESS ADDRESS *

ANNUAL INCOME *

UNDERTAKING

I hereby certify that all information herein and herewith furnished are all in respects true and correct and submitted for the purpose of application of membership to St. Vincent Ferrer Parish Multi-Purpose Cooperative. It is also agreed that the Cooperative may inquire into their correctness by the methods it may deem proper to use and that this document shall remain the property of St. Vincent Ferrer Parish Multi-Purpose Cooperative whether or not the membership application is approved or disapproved by the Board of Directors.

Note: Upload a picture of 1 Government Issued IDs placed on top of a white piece of paper with 3 signatures.

SIGNNATURE *

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Note: Valid and acceptable IDS's. See example

GOVERNMENT ID

ID FRONT SIDE *

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Accepts *.jpeg, *.jpg, *.png and max. file size of 20mb.

ID BACK SIDE *

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Accepts *.jpeg, *.jpg, *.png and max. file size of 20mb.