Individual Member Census Form: Dayong For Purok 1 Km.125 La Esperanza Tulunan, Cotabato

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DAYONG FOR PUROK 1

KM.125 LA ESPERANZA
TULUNAN, COTABATO

DATE: ________________________

INDIVIDUAL MEMBER CENSUS FORM


A. APPLICANT NAME: ____________________________________________________ AGE:_______
FIRSTNAME MI SURENAME

BIRTHDATE:____________ BIRTHPLACE: _____________________________

B. SPOUSE NAME: _____________________________________________________ AGE:________


FIRSTNAME MI SURNAME

BIRTHDATE:______________ BIRTHPLACE:____________________________

DATE OF MARRIAGE:_________________ PLACE:______________________

C. CHILDREN / DEPENDENT

NAMES AGE BIRTHDAY RELATION


1. _________________________________,_____________,__________________, __________________

2. _________________________________,_____________,__________________,__________________

3. _________________________________,_____________,__________________,__________________

4. _________________________________,_____________,__________________,__________________

5. _________________________________,_____________,__________________,__________________

6. _________________________________,_____________,__________________,__________________

D.MEMBERSHIP OBLIGATION

1. MEMBERSHIP FEE : P ___________________

2. MONTHLY DUES: P ___________________

PLEDGE OF LOYALTY
I___________________________________________________________ OF LEGAL AGE
RESIDENT OF_______________________________________ VOLUNTARY SUBMIT MYSELF AND TO
ABIDE ALL THE LAW AND POLICIES SET BY THE MANAGEMENT I WILL DO MY BEST TO KEEP THIS
ORGANIZATION STRONG AND HEALTHY THROUGH MY KIND AND UNDERSTANDING WITH MY
FELLOW MEMBERS AND SHARE WHATEVER CONTRIBUTION I CAN DO SO HELP ME GOD .

_______________________________________
SIGNATURE OF MEMEBER

RECOMMENDING APPROVAL:_______________________________________________________________

APPROVED BY: ______________________________ ____________________________________


DAYONG SECRETARY DAYONG TREASURER

____________________________________
DAYONG PRESIDENT

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