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    Lemos New

    Uploaded by

    Donna Fe Patiluna
    The document is an application form for membership in the Legitimate Member Mortuary System (LEMOS). It requests personal information from applicants such as name, date of birth, address, occupation, and emergency contacts. Applicants must be regular members of Barbaza Multi-purpose Cooperative. They agree to pay a non-refundable 250 peso registration fee and that benefit claims will be based on their tenure of membership, ranging from 6,500 to 15,000 pesos.

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

    Lemos New

    Uploaded by

    Donna Fe Patiluna
    34 views1 page
    The document is an application form for membership in the Legitimate Member Mortuary System (LEMOS). It requests personal information from applicants such as name, date of birth, address, occupation, and emergency contacts. Applicants must be regular members of Barbaza Multi-purpose Cooperative. They agree to pay a non-refundable 250 peso registration fee and that benefit claims will be based on their tenure of membership, ranging from 6,500 to 15,000 pesos.

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    mortuary form

    Original Title

    LEMOS-NEW

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    The document is an application form for membership in the Legitimate Member Mortuary System (LEMOS). It requests personal information from applicants such as name, date of birth, address, occupation, and emergency contacts. Applicants must be regular members of Barbaza Multi-purpose Cooperative. They agree to pay a non-refundable 250 peso registration fee and that benefit claims will be based on their tenure of membership, ranging from 6,500 to 15,000 pesos.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views1 page

    Lemos New

    Uploaded by

    Donna Fe Patiluna
    The document is an application form for membership in the Legitimate Member Mortuary System (LEMOS). It requests personal information from applicants such as name, date of birth, address, occupation, and emergency contacts. Applicants must be regular members of Barbaza Multi-purpose Cooperative. They agree to pay a non-refundable 250 peso registration fee and that benefit claims will be based on their tenure of membership, ranging from 6,500 to 15,000 pesos.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    APPLICATION FOR LEGITIMATE MEMBER MORTUARY SYSTEM APPLICATION FOR LEGITIMATE MEMBER MORTUARY SYSTEM

    (LEMOS) (LEMOS)
    The undersigned hereby applies for membership to the Legitimate Member Mortuary The undersigned hereby applies for membership to the Legitimate Member Mortuary
    System in accordance with the terms and conditions set forth below.
    I. PERSONAL INFORMATION (Please and DO NOT use abbreviation and answer all items) I. PERSONAL INFORMATION (Please and DO NOT use abbreviation and answer all items)

    FIRST NAME LAST NAME MIDDLE NAME SEX ( ) Male FIRST NAME LAST NAME MIDDLE NAME SEX ( ) Male
    ( ) Female ( ) Female

    Date of Birth Age: Civil Status Date of Birth Age: Civil Status

    Present Address: Contact No. / Email Add: Occupation: Present Address: Contact No. / Email Add: Occupation:

    Employer: Employer:

    Office Address: Religion: No. of Dependents: Office Address: Religion: No. of Dependents:

    Name of Spouse: Name of Spouse:


    Person to claim the benefits (In order of preference) Person to claim the benefits (In order of preference)
    Name Age Address Relationship Name Age Address Relationship

    1 _________________________ _______ _____________________________ __________________ 1 _________________________ _______ _____________________________ __________________

    2 _________________________ _______ _____________________________ __________________ 2 _________________________ _______ _____________________________ __________________

    3 _________________________ _______ ______________________________ __________________ 3 _________________________ _______ ______________________________ __________________

    I hereby certify that the above –stated information is true, complete and correct. I do hereby I hereby certify that the above –stated information is true, complete and correct. I do hereby
    agree to the following guidelines: agree to the following guidelines:

    1. I am regular member of Barbaza Multi-purpose Cooperative, 1. I am regular member of Barbaza Multi-purpose Cooperative,
    2. I am paying a registration fee of P250.00 and this amount is not refundable in case I with- 2. I am paying a registration fee of P250.00 and this amount is not refundable in case I with-
    draw from membership; draw from membership;
    3. Benefit claim will be made upon submission of the death certificate, 3. Benefit claim will be made upon submission of the death certificate,
    4. The amount of Benefit claim will be based on my tenure of membership to LEMOS as follows: 4. The amount of Benefit claim will be based on my tenure of membership to LEMOS as follows:
    Below 1 year ----------------------------- Php 6,500.00 Below 1 year ----------------------------- Php 6,500.00
    1 year but less than 3 years --------- Php 7,500.00 1 year but less than 3 years --------- Php 7,500.00
    3 years but less than 5 years -------- Php 10,000.00 3 years but less than 5 years -------- Php 10,000.00
    5 years and above ----------------------Php 15,000.00 5 years and above ----------------------Php 15,000.00

    ____________________________ ____________________________
    Signature of Applicant Signature of Applicant

    APPROVED: APPROVED:

    __________________________________ _____________________ __________________________________ _____________________


    Approving Authority Date Approving Authority Date

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