MAGCOOP MULTIPURPOSE COOPERATIVE
CIN: 0105162472
Loan Application Form
Client Type
Allottee
Crew
Employee
ID Number
ID Validity
First Name
Middle Name
Please input 'N/A' if none.
Last Name
Date of Membership
Email Address
Address
City / Province
ABRA
AGUSAN DEL NORTE
AGUSAN DEL SUR
AKLAN
ALBAY
ANGELES CITY
ANTIQUE
ANTIPOLO CITY
AURORA
BAGUIO CITY
BACOLOD CITY
BASILAN
BATANES
BATAAN
BATANGAS
BENGUET
BILIRAN
BOHOL
BUKIDNON
BULACAN
CABANATUAN CITY
CAGAYAN
CAGAYAN VALLEY
CALOOCAN CITY (SOUTH)
CALOOCAN CITY(NORTH)
CAMIGUIN
CAMARINES NORTE
CAMARINES SUR
CAPIZ
CATANDUANES
CAVITE
CAGAYAN DE ORO CITY
CEBU
CAINTA RIZAL
DAGUPAN CITY
DAVAO
DAVAO DEL NORTE
DAVAO DEL SUR
DIPOLOG CITY
DUMAGUETE CITY
DAVAO ORIENTAL
GENERAL SANTOS CITY
GINGOOG CITY
GUIMARAS
IFUGAO
ILIGAN CITY
ILOILO
ILOCOS NORTE
ILOCOS SUR
IRIGA CITY
ISABELA
JAGNA
KALOOKAN
KALINGA-APAYAO
LANAO DEL NORTE
LANAO DEL SUR
LAGUNA
LAPU-LAPU CITY
LA UNION
LAOAG CITY
LEGASPI CITY
LEYTE
LIPA CITY
LAS PINAS
LUCENA CITY
MAGUINDANAO
MALABON
MANDAUE CITY
MANDALUYONG
MARINDUQUE
MARIKINA
MASBATE
MINDORO
MISAMIS OCCIDENTAL
MISAMIS ORIENTAL
MAKATI
MANILA
METROPOLITAN MANILA
MOUNTAIN PROVINCE
MUNTINLUPA
N/A
NAGA CITY
NAIC
NAVOTAS
NORTH COTABATO
NUEVA ECIJA
NEGROS ORIENTAL
NEGROS OCCIDENTAL
NUEVA VIZCAYA
OROQUIETA CITY
OCCIDENTAL MINDORO
OLONGAPO CITY, ZAMBALES
ORMOC CITY
ORIENTAL MINDORO
OZAMIS CITY
PAGADIAAN CITY
PALAWAN
PAMPANGA
PANGASINAN
PASAY CITY
PASIG
PATEROS
PUERTO PRINCESA CITY
PARANAQUE
QUEZON CITY
QUEZON
QUIRINO
RIZAL
ROMBLON
ROXAS CITY
SAMAR
SAMAR, EASTERN
SAMAR, NORTHERN
SAMAR, WESTERN
SARANGANI
SIQUIJOR
SAN JUAN
SOUTHERN LEYTE
SULTAN KUDARAT
SAN MIGUEL BULACAN
SOUTH COTABATO
SORSOGON
SAN PABLO CITY
SULU
SURIGAO CITY
SURIGAO DEL NORTE
SURIGAO DEL SUR
TACLOBAN CITY
TAGUIG
TAGAYTAY CITY
TAGBILARAN CITY
TAGUM CITY
TARLAC
TAWI-TAWI
TAYTAY
TANGUB CITY
VALENZUELA
ZAMBALES
ZAMBOANGA DEL NORTE
ZAMBOANGA DEL SUR
ZAMBOANGA SIBUGAY
ZAMBOANGA CITY
Date Of Birth
Telephone Number
Mobile Number
Gender
Female
Male
Civil Status
Single
Single Parent
Married, Spouse not working
Married, Spouse also working
No. of Children
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of Spouse
Living Status
Renting
Living with Parents/Relatives for free
House is Owned and Mortgaged
House is Owned
Crew Information
Name of Crew
Date Of Birth
Date Hired
Contract Period
Join date - End date
Company / Fleet
Position Level
Junior Ratings
Senior Ratings
Junior Officer
Senior Officer
Rank and File
Supervisor
Managerial
Executive
Position
Experience
Please input 0 if less than a year.
Medical History
Fit with Medications
Fit for Sea Duty (With Repat History)
Fit for Sea Duty (Without Repat History)
Vessel
Loan Application Details
Type of Loan
Loan Amount
Term
Manner of Loan Payment
To be deducted from allotment of:
Crew
Allottee
Name of Allottee
Payroll deduction
Manner of Loan Release (Please provide an active and valid PHILIPPINE bank account. Dollar accounts will NOT be processed.)
Credit Memo
Bank Cheque
Account Name
Bank Acct. Number
Bank Name / Branch
Payable to
Loan Requirements
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agree
that MAGCOOP may collect, use, disclose and process my personal information set out in this form and/or otherwise provided by me for one or more of the following purposes: verifying if client is qualified for a loan; verifying the client’s identity; records purposes; documentary purposes; and providing updates on cooperative services, products and events.
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