NOVADECI - MEMBERSHIP FORM
Personal Information
Address / Education
Source of Income / Identification
Dependents / Beneficiaries
Upload Requirements
By filling out the MEMBERSHIP APPLICATION FORM you are consenting to the collection, processing and use of the information in accordance to Republic Act 10173 or Data Privacy Act of 2012.
Member's personal data obtained from this portal is entered and stored within the company's authorized information and communications system and will be accessed by Membership Department authorized personel.
The MIS Department have instituted appropriate organizational, technical and physical security measures to ensure the protection of the member's personal data.
To proceed with your membership application, please prepare the following requirements:
✓
Mandatory -
[Photo w/ white background] [Proof of Billing] [Residence Sketch]
✓
Optional -
[Payslip/Code] [Mayor's Permit] [DTI Certificate] [Marriage Contract] [Birth Certificate] [Birth Certificate of Dependent/Beneficiaries]
Membership Process:
STEP 1
: Fill up application form
STEP 2
: Pay online via GCASH or PAYMAYA. Send the screenshot of the proof of transaction/payment thru this link
https://bit.ly/3Rg2QlR
or thru NOVADECI official Facebook page
https://bit.ly/3exHwVo
STEP 3
: Wait for the ZOOM LINK to be sent via text message. Make sure to type your FULL NAME upon joining the zoom meeting.
Accept
Personal Information
Last Name
*
First Name
*
Middle Name
*
Suffix
Sr.
Jr.
I
II
III
IV
V
Birthdate
*
Age
Birth Place
*
Gender
*
Male
Female
Civil Status
*
Single
Married
Widow(er)
Legally Separated
Nickname
Nationality
*
Religion
*
Branch/Satellite
*
Bagong Silang
Bulacan
Camarin
Fairview
Head Office
Kiko
Lagro
Cubao
Tandang Sora
CONTACT INFORMATION
Landline No.
Mobile No.(ex.0966xxxxxxx)
*
Email
*
SPOUSE INFORMATION
Last Name
*
First Name
*
Middle Name
*
Suffix
Sr.
Jr.
I
II
III
IV
V
Birthdate
*
PB No./MemId
Permanent Address / Educational Information
Unit/Room#/Floor
Building Name
Lot/Block/House/Bldg.No.
*
Street
*
Subdivision/Village
Barangay
*
Municipality/City
*
Province
*
Zip Code
*
Resident Status
*
Owned
Rented
Lot Status
*
Owned
Mortgage
Length of Stay
*
PREFERRED MAILING ADDRESS
Mailing Address
*
Permanent Home Address
Employer Address
Business Address
EDUCATIONAL INFORMATION
Educational Attainment
*
Post Graduate
College Graduate
Vocational
High School
Elementary
School
Course
Source of Income / Identification
SOURCE OF INCOME (FOR EMPLOYEES)
Position/Occupation
Employer Name
Employer Address
Office Number
Employment Status
Part-time
Contractual
Regular
Years in Service
Salary
SOURCE OF INCOME (FOR SELF-EMPLOYED)
Nature of Business
Business Name
Business Address
Office Number
Form of Business
Sole Proprietorship
Partnership
Corporation
Years in Current Business
Monthly Income
IDENTIFICATION
TIN #
*
SSS #
*
GSIS #
PAGIBIG #
Philhealth #
Driver's License #
Passport #
PRC #
NBI #
Dependents / Beneficiaries
DEPENDENTS
1. Name
*
Birthdate
*
Relationship
*
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Contact No.(ex.0966xxxxxxx)
*
2. Name
Birthdate
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Contact No.(ex.0966xxxxxxx)
3. Name
Birthdate
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Contact No.(ex.0966xxxxxxx)
4. Name
Birthdate
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Contact No.(ex.0966xxxxxxx)
5. Name
Birthdate
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Contact No.(ex.0966xxxxxxx)
6. Name
Birthdate
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Contact No.(ex.0966xxxxxxx)
BENEFICIARIES
1. Name
*
Civil Status
*
Single
Married
Widow(er)
Legally Separated
Birthdate
*
Contact No.(ex.0966xxxxxxx)
*
2. Name
Civil Status
Single
Married
Widow(er)
Legally Separated
Birthdate
Contact No.(ex.0966xxxxxxx)
3. Name
Civil Status
Single
Married
Widow(er)
Legally Separated
Birthdate
Contact No.(ex.0966xxxxxxx)
PARENT'S INFORMATION
FATHER'S DETAILS
Father's Last Name
*
Father's First Name
*
Father's Middle Name
*
Suffix
Sr.
Jr.
I
II
III
IV
V
Birthdate
*
PB No.
MOTHER'S DETAILS
Mother's Last Name
*
Mother's First Name
*
Mother's Middle Name
*
Suffix
Sr.
Jr.
I
II
III
IV
V
Birthdate
*
PB No.
FAMILY MEMBERS / RELATIVES WHO ARE MEMBERS OF NOVADECI
1. Name
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Address
Contact No.(ex.0966xxxxxxx)
2. Name
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Address
Contact No.(ex.0966xxxxxxx)
3. Name
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Address
Contact No.(ex.0966xxxxxxx)
4. Name
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Address
Contact No.(ex.0966xxxxxxx)
5. Name
Relationship
Father
Mother
Brother
Sister
Son
Daughter
Nephew
Niece
Aunt
Uncle
Siblings
Husband
Wife
Spouse
Fiance
Fiancee
Father in Law
Mother in Law
Brother in Law
Sister in Law
Address
Contact No.(ex.0966xxxxxxx)
Requirements
MEMBER WHO RECOMMENDED /REFERRED YOU TO NOVADECI: (MGM PROMO)
Name
Contact No.(ex.0966xxxxxxx)
PB No./Member ID
QUESTIONS THAT NEED TO BE ANSWERED
Have you been a member of NOVADECI?
*
Yes
No
What motivates you in joining NOVADECI?
*
UPLOAD REQUIREMENTS
Upload your Photo
*
Upload Payslip/COE
Upload Proof of Billing
*
Upload Mayor's Permit
Upload DTI
Upload Marriage Contract
Upload Birth Certificate
Upload Residence Sketch
*
1. Birth Certificate - Beneficiaries/Dependent
2. Birth Certificate - Beneficiaries/Dependent
3. Birth Certificate - Beneficiaries/Dependent
DOCUMENTS SUBMITTED
Proof of Billing
Payslip/COE
Mayor's Permit
DTI
Marriage Contract
Birth Certificate
Birth Certificate (Beneficiaries)
Others
MEMBERSHIP AND SUBSCRIPTIONS AGREEMENT
The Board of Directors
Novaliches Development Cooperative
NOVADECI Bldg., Buenamar corner
Sarmiento St., Novaliches
Quezon City
Gentlemen:
I
, a resident of
hereby agree to be a member of NOVADECI. I will undergo the training course prescribed for prospective members and I understand the puposes and objectives of this cooperative.
In connection with such membership, I hereby agree to the following terms and conditions:
1. To comply with the provision of the Articles of Cooperation, the By-laws, Code of Ethics and other policies set by the Board, the General Assembly as well as acts of duly constituted
authorities and failure on my part to do so, NOVADECI, at its option, may:
a). Fine
b). Suspend or
c). Expel me from membership, whereupon all my shareholding in, shall be answerable for my liabilities' to NOVADECI.
2. To attend general assembly, meetings, conference, seminars as required by the Board of Directors and failure to my part to do so, unless previously excused by the Board, to pay the fine of
P____________ and make up for the activity I have missed.
3. To participate in the planned thrift and savings program by:
a). Subscribing for atleast 150 shares valued at FIFTEEN THOUSAND PESOS (Php15,000) and paying for them either in lump sum or in regular installments within ten (10) years. if the 150
shares has already been paid, I will continue on subscribing another shares of at least php1,500.00 annually.
b). Share Capital shall not be withdrawn and should not be used in offsetting obligations whether past due or current while the membership subsists (RA #9520 Rule 10 Sec. 3).
c). Contributing at least 5% of every loan granted me and at least 50% of the annual interest and patronage refund due to me with automatic deduction on loan proceeds or ICPR. Failure on
my part to comply with my financial obligation unless excused by the Board, shall make me liable for a fine of 2% a month on the amount default.
4. To pay the membership fee of Php ____________.
5. To patronize the NHCP, NMSB and other services of NOVADECI and pay my obligations on time.
6. To maintain my member in good standing (MIGS) status at all time.
7. To comply with the directives of duly constituted authorities as well as the decision of the Board regarding the operating policies of NOVADECI.
( Note: Other conditions may be included depending upon the nature of the business of the cooperative. )
The provisions of this agreement, the articles of incorporation and by-laws have been explained to me and understand them and agree to abide with all of them.
In all of the above undertakings, I am aware that the Board of Directors and the cooperative may impose sanctions against me or perform any acts necessary to make the sanction(s) effective without going to court.
Ma.Theresa G. Drueco
Chairperson of the Board
Conforme / Accept