Online Membership FormPlease fill out the fields below. We promise your information will be stored safely on our server.Disclaimer: Before filling out this membership form, please make sure to watch our PMES video first. This is important because Step 2 requires you to upload the following:a valid IDyour PMES certificatea screenshot of your completed PMES answer sheet These will serve as proof that you have successfully watched our online PMES video. ๐ Watch the PMES VIDEO here.Please enable JavaScript in your browser to complete this form. - Step 1 of 4Please Select: *New MemberFor UpdatingName *FirstMiddleLastGender *MaleFemaleLGBTQ+Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraรงaoCyprusCzech RepublicCรดte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRรฉunionSaint BarthรฉlemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTรผrkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweร land IslandsCountryLayoutDate of Birth (mm/dd/yyyy) *Civil Status *SingleLegally MarriedSeparatedWidowerAnnuledMobile Number *Facebook NamePlace of Birth *Nationality *EmailLayoutWhich Branch do You Prefer? *BansalanBansalanCalinanDigosGensanGlanHagonoyKapataganKiblawanKidapawanKoronadalMalandagMatanaoPolomolokSta. CruzSulopSurallahTorilBest Way to Contact you *Mobile NumberEmail AddressFacebookAre You a OFW? *YesNoAre You a OFFM (Overseas Filipino Family Member)? *YesNoLocation *NextAttachmentUpload your Photo * Click or drag a file to this area to upload. Upload an Image of your ID with Signature and ID number * Click or drag a file to this area to upload. Online PMES Certificate Screenshot * Click or drag a file to this area to upload. Online PMES Answer Sheet Screenshot * Click or drag a file to this area to upload. PreviousNextPMES Evaluation Answer SheetInstructions: Please evaluate the seminar by checking the appropriate box using the scale:5 - Strongly Agree | 4 - Agree | 3 - Neutral | 2 - Disagree | 1 - Strongly DisagreeI. Seminar Content and RelevanceStatement1. The topics discussed were relevant and informative. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly Disagree2. The objectives of the seminar were clearly explained. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly Disagree3. I now better understand the role of a cooperative member. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly Disagree4. The presentation helped me appreciate the value of joining a cooperative. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly DisagreeII. Speaker and FacilitationStatement1. The facilitator/speaker was knowledgeable. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly Disagree2. The speaker encouraged interaction and welcomed questions. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly Disagree3. The speaker presented the topics clearly and effectively. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly DisagreeIII. Overall EvaluationStatement1. Overall, I am satisfied with the seminar. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly Disagree2. I feel confident in applying for membership in the cooperative. *5 - Strongly Agree4 - Agree3 - Neutral2 - Disagree1 - Strongly DisagreeIV. Comments and Suggestions:1. What did you like most about the seminar? *2. What improvements can be made? *PreviousNextTerms and ConditionsI hereby apply for membership in the BANSALAN MULTIPURPOSE COOPERATIVE, and agree to faithfuly obey its rules and regulations as set down in its Articles of Cooperation and By-Laws and amendments thereof, or elsewhere, and the decisions of the general membership meeting as well as those of the Board of Directors.DECLARATION OF SPECIMEN SIGNATUREI, whose specimen signature appears below, confirm that all the information disclosed in this member information is correct and complete. Any Changes in the foregoing information shall be communicated to the Cooperativ. I hereby authorize the Cooperative to Verify and investigate any and all information given by me which the Coop may deem appropriate.I hereby acknowledge and authorize the Cooperative:The regular submission and disclosure of my basic credit data (as defined under the Republic Act No.9150 and itโs implementing Rules and Regulations) to the Credit Information Corporation (CIC) as well as any updates or correction thereof;In sharing of my basic credit data with other lenders authorize by the CIC and credit reporting agencies duly accredited by the CICSUBSCRIPTION AGREEMENTAs a member of BANSALAN MULTIPURPOSE COOPERATIVE I hereby pledge to subscribe for 80 share/s (common) with par value of P100,000 which is equivalent to EIGHT THOUSAND PESOS (Php8,000) I promise to pay the above stated subscribe shares within the period of________ which is payable every: (weekly, by monthly, monthly, quarterly, semiannually) in the amount of ________As a Member in Good Standing, I hereby promise to abide with the cooperatives by-laws, rules and regulations mandated under RA 9520 (The Philippine corporative code of 2008).I Agree to the Terms and Conditions *AgreePreviousSend Information