Name of Organization

Registered Address

Contact Numbers

Email Address(optional)

Date Organized

Sector/s Represented

Registering Ageny:

Date Registered
  Securities and Exchange Commission(SEC)
  Cooperative Development Authority(CDA)
  Department of Labor and Employment(DOLE)
  National Commission on Indigenous People(NCIP)*certification
  Department of Human Settlements and Urban Development(DHSUD)
  Others  

please, specify:

 

Accrediting Agency:

Date Accredited

  Commission on Population and Development(POPCOM)
  Department of Agriculture
  Department of Public Works nd Highways(DPWH)
  Department of Social Welfare and Development(DSWD)
  Department of Interior and Local Government
  Department of Labor and Employment(DOLE)
  National Commission for Culture and the Arts(NCCA)
  Presedential Commission on Urban Poor(PCUP)
  Philippine Drug Enforcement Agency(PDEA)
  Others  

please, specify:

Organizational Level:

    Barangay-Level
    Chapter
    Affiliate of a Larger organization  

(Identify Organization)

    Others,  

please, specify:  

Depending on your organization's technical area of expertise and scope of activity, which Local Special Body are you most capable to be a member of?

    Local Development Council
    Local School Board
    Local Health Board
    Local Peace and Order Council

List of Members:(Use seperate sheet)

    Within the LGU
    Outside of the LGU,if any

WE HEREBY CERTIFY to the correctness of the above information

    Secretary
    President