Professional Documents
Culture Documents
First
Middle
Last
Nationality:
___/___/_____
Place of Birth:
Religion: __________________
________________________
Married
SSS/GSIS Number:
Legally Separated
___________________
________________________
Annulled
Widowed
Other IDs:
________________________
AB
Others (specify)
Physical Disabilities:
___________________
Undergoing
Medical
Treatments
at
present?
Yes
No
(if
yes,
specify)
________________________________________
When:
_____________________________________
Details
of
last
hospital
confinement:
_______________________
In
case
of
emergency,
contact
person:
________________________________________
No.:
________________________
Interested
to
open
business
venture?
Yes
No
(if
yes,
__________________________________________
Knowledgeable in the said business? Yes No
Directory listing yes no
specify)
Family Members:
Name
Relationshi
p
Educational Background:
Level
Ag
e
Employmen
t
Name of School
Ave.
Monthly
Income
Already
a Coop
Member?
(YES /
NO)
Course
Living in
the same
househol
d?
(YES /
NO)
Year
Graduated
Elementary
High School
Technical School
College
Post Graduate
CONTACT DETAILS
Present
Address:
Zip Code:
______________________________________________________________________________________________
St. No.
St. Name
_______
Barangay
City
________________________
Date
Previous
Address:
Zip Code:
_____________________________________________________________________________________________ __________
No.
St. Name
Barangay
City
Address/Permanent
Address
(if
applicable):
Zip Code
_____________________________________________________________________________________________
St. No.
St. Name
__________
Barangay
City
Mobile Number:
_____________________________
Home Phone Type:
__________________________
Prepaid
Email Address:
___________________________________________
Mailing Address:
Postpaid
Prepaid
Postpaid
___________________________________________________________
St
. No.
St. Name
Barangay
City
EMPLOYMENT DETAILS
SELF-EMPLOYED
EMPLOYED
UNEMPLOYED
Employer/Business Name:
Name of Business:
housewife
_________________________________________
_________________________________________
Office Address:
Type of Business:
student
_________________________________________
Nature
Nature
of
Business:
_______________________
Office
No:
of
_______________________
______________Fax
No.:
_________
Asset
Size
of
Business
(Php):
_______________
Employment Type:
Private
Share
in
Government
____________________
Others: _________________
Monthly
Employment
Business:
Status:
Regular
Business
(%):
Income
_________________________
Probationary
Others: ___________________
Position/Rank __________________________
Monthly Income ________________________
Are you a member of another organization (coop, ngos, etc) yes (specify)_________________
Position: _____________________
Type of Account
Branch
Card Issuer
CHARACTER REFERENCES
Relation
Address
Name
Name
Type of Loan
Monthly Gross
Income
Member Since
Contact Number
TRADE REFERENCES
*if self-employed put at least two (2) trade references
Business
Address
Contact No.
Other
Monthly
Income
Maturity Date
Annual
Taxes
Loan
Payments
I/We hereby certify that all the data and statements in this application are correct and are made for the
purpose of obtaining credit, and the signature(s) appearing thereon is(are) genuine. I/We authorize you to
obtain such information as you may require connecting the statements made in this application and that
the sources which you may apply are authorized to provide any information relative to this application.
I/We agree this will remain your property whether the credit is granted or not.
_____________________________________
____________________________________
Membership
Committee
_________________________
4. PMES
Manager
Application
Date/s
no.:___________________
conducted:_________________
PMES Result:
Remarks:
Date
Received:____________________
CI/BI
Interviewed
Submitted:__________
by:___________________
Recommendation:
Results
Date
Interviewed:_________________
Date
of
PMES:____________________
PMS Batch No.:___________
Date
of
PMES:
___________________
BOARD OF DIRECTORS
COOP MANAGEMENT
TEAM (COMAT)
CREDIT
COMMITTEE
Signature of Secretary
Date Approved:
Received
Credit Limit:
SKETCH/LANDMARK OF RESIDENCE
Certified by:
__________________________________
(Opisyales o Myembro ng coop na nag recruit o nag imbita sa kalahok ng PMES)
Petsa: _______________________________