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    Civil Society Organization APPLICATION-ForM

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    Anonymous dtceNuyIFI
    This 3 page document is an application form for Civil Society Organizations (CSOs) seeking accreditation from the Philippine Department of Agriculture (DA) to receive public funds. The form requests basic information about the CSO, contact details, purposes for organizing, estimated funds requested, description of social issues/projects, and authorization for DA inspection and verification. It also includes a 2 page bio data form for CSO board members detailing personal information, education, and employment history.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Civil Society Organization APPLICATION-ForM

    Uploaded by

    Anonymous dtceNuyIFI
    1K views3 pages
    This 3 page document is an application form for Civil Society Organizations (CSOs) seeking accreditation from the Philippine Department of Agriculture (DA) to receive public funds. The form requests basic information about the CSO, contact details, purposes for organizing, estimated funds requested, description of social issues/projects, and authorization for DA inspection and verification. It also includes a 2 page bio data form for CSO board members detailing personal information, education, and employment history.

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    Civil Society Organization APPLICATION-ForM

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    This 3 page document is an application form for Civil Society Organizations (CSOs) seeking accreditation from the Philippine Department of Agriculture (DA) to receive public funds. The form requests basic information about the CSO, contact details, purposes for organizing, estimated funds requested, description of social issues/projects, and authorization for DA inspection and verification. It also includes a 2 page bio data form for CSO board members detailing personal information, education, and employment history.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views3 pages

    Civil Society Organization APPLICATION-ForM

    Uploaded by

    Anonymous dtceNuyIFI
    This 3 page document is an application form for Civil Society Organizations (CSOs) seeking accreditation from the Philippine Department of Agriculture (DA) to receive public funds. The form requests basic information about the CSO, contact details, purposes for organizing, estimated funds requested, description of social issues/projects, and authorization for DA inspection and verification. It also includes a 2 page bio data form for CSO board members detailing personal information, education, and employment history.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    DA-CSO APPLICATION FORM

    REPUBLIC OF THE PHILIPPINES


    DEPARTMENT OF AGRICULTURE

    APPLICATION FORM FOR THE ACCREDITATION OF CIVIL SOCIETY ORGANIZATION/S (CSO)


    AS BENEFICIARY OF GOVERNMENT OR PUBLIC FUNDS

    Information on previous DA CSO Accreditation if applicable


    Previous DA CSO
    Accreditation No.
    Date Issued
    Date of Expiration

    BASIC INFORMATION:

    Complete name of CSO


    (as stated/indicated on the registration papers)
    Other Name
    (e.g., acronym, short name, previous name, etc.)
    No. and Street
    Principal address or
    Barangay
    place where the
    Municipality
    CSO operates as a
    Province
    group
    Zipcode
    Name
    Head of CSO
    Position/Designation
    Landline No.
    Mobile No.
    Contact Details
    Email Address
    Website
    Name
    Coordinator/Staff-in-
    Position/Designation
    Charge of Branch or
    Satellite Office/s if
    Contact Number
    there is any

    Purposes or reasons for organizing or forming


    as a group
    Government Agencies (Gas) from which the
    CSO expects to receive public funds
    Estimated amount of public funds to be
    requested from the Gas

    SOCIAL PREPARATION: (USE ADDITIONAL SHEET IF NECESSARY)

    Social Issue/Problem Description of Geographical Location Beneficiary Sector/s:


    Program/Project (pls. indicate specific Barangay,City/ (Fisher folks, Farmers, Persons with
    Municipality, Province and Region) Disabilities, Children, Indigenous People,
    Older Persons, Cooperative members,
    mixed group, etc.)

    DA-CSO APPLICATION FORM / BENEFICIARY CSO 1


    DA-CSO APPLICATION FORM

    AUTHORIZATION:

    On behalf of the CSO Applicant, I hereby:


    (a) Authorize the DA to inspect the premises of the office(s) of the CSO Applicant, as well as the
    site of any past or present project or program of the CSO Applicant, and
    (b) Authorize any concerned person to disclose the DA any fact material to the validation of any
    information provided by the CSO Applicant in this application or in any of the documents
    submitted in support thereof.

    AFFIANT- Signature
    Authorized Name
    Representative Position/Designation
    Date executed
    Place executed

    SUBSCRIBED AND SWORN to before me, on the above date and place, affiant exhibiting the
    following identification document:
    Government ID type and No.
    Place and date of issue
    Valid until

    Doc. No. Signature


    Name of Notary
    Page No.
    Public
    Book No. Address
    Commission valid
    Series of
    until

    DA-CSO APPLICATION FORM 2


    BIO DATA PICTURE

    Personal Information

    Name
    Position in the Board
    Home Address
    Date of Birth
    Contact Number
    Email Address
    Nationality

    Educational Attainment

    Employment Record
    1. Position
    Employer
    Dates
    Duties

    2. Position
    Employer
    Dates
    Duties

    CERTIFICATION

    I, the undersigned, certify certify that these data are true and correct

    Signature
    Date

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