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Republic of the Philippines

ACCREDITATION NUMBER

SOCIAL SECURITY SYSTEM

COOPERATIVE
ACCREDITATION
(06-2011)

Please read instructions at the back before accomplishing this form. Print all information in capital letters and use black ink only.
PART I - INFORMATION
EMPLOYER ID NUMBER
NAME OF COOPERATIVE
PRINCIPAL OFFICE ADDRESS (Room/Floor/Bldg No./Name)

(Street)

(Subdivision/Village)
(City/Municipality)

(Barangay/District/Locality)
(Province)

START
OF

O
PE
R

ATION (mm/dd

TYPE OF COOPERATIVE:

1__LJ____

AREAS OF OPERATION:

PRODU
CERS
E-MAIL ADDRESS

MARKET
ING

FAX NUMBER (AREA CODE)

111111111

11 1 1 1CREDIT
1111

NUMBER OF
MEMBERS

CONSUMERS

TELEPHONE NUMBER (AREA CODE)

yy
yy
)

POSTAL CODE

SERVICE

OTHERS: (Specify)

PART II - CERTIFICATION

MULTI PURPOSE

I certify that the information provided in this form are true and correct.
PART III - TO BE FILLED OUT BY SSS
A. RECEIVING BRANCH
RECEIVED BY:
SIGNATURE OVER PRINTED NAME

OFFICIAL DESIGNATION

DATE

RECEIVING BRANCH REVIEWED BY


YEAR 2 NAME
YEAR
1
SIGNATURE
OVER PRINTED
DATEYEAR 3TIME
B. INVESTMENTS RESEARCH AND SUPPORT DEPARTMENT
RECEIVED BY:
ENCODED BY:

EVALUATED BY:
REVIEWED BY: CONFIRMED BY:

REMARKS:
CAPITALIZATION:

CURRENT RATIO:
QUICK RATIO:
SIGNATURE OVER PRINTED NAME
DATE
3-YEAR PROFITABILITY NET INCOME (LOSS)

DATA CONTROLLED BY:


TIME
DATE
DATE
SIGNATURE OVER PRINTED NAME
SIGNATURE OVER PRINTED NAME
SIGNATURE OVER PRINTED NAME
DATE
SIGNATURE OVER PRINTED NAME
C. MEMBERSHIP SECTION, DILIMAN BRANCH

SIGNATURE OVER PRINTED NAME

DATE

SIGNATURE OVER PRINTED NAME

DATE

DATE

INTRUCTIONS
1.
2.
3.
a)
b)
c)
d)
e)

Fill out this form in two (2) copies and accomplish Parts I & II signed by the President/Chairman.
Submit this form to the nearest SSS Branch having jurisdiction over your operation with Cooperative Member List and the
required documents duly marked "a-m" below.
This application shall be submitted with the following documents:
Articles of Incorporation
By-Laws
Economic Survey
Certificate of Registration with the Cooperative Development Autority
A favorable endorsement, issued not earlier than six (6) months prior to the time of filing the application, from the proper
government agency in case of cooperatives engaged in the following activities:
Activity

Air Transport
Banking,Pawnshops, & other excersices with quasibanking
functions
Professional Boxing
Operation of games of chance
Educational Institution (College/Tertiary)
Educational Institution (Elementary/Secondary)
Educational Institution (Technical/Vocational)
Electric Power Plants
Hospitals
Insurance

Games and Amusement Board


Philippine Charity Sweepstakes Office
Commission on Higher Education
Department of Education
Technical and Skills Development Authority
Department of Energy
Department of Health
Insurance Commission

Land Transport
Construction of water transport/vessel
Operation of Radio,Television, telephone

Land Transportation Franchising and Regulatory Board


Maritime Industry Authority
National Telecommunications Commision

Recruitment for overseas Employment


Security Agency
Manufacture, repair, storage and/or distribution of products
and/or ingredients of firearms, gunpowder and all those
indicated in E O 95.s 2002 Foreign Investment Negative list.

Philippine Overseas Employment Administration


Philippine National Police

Manufacture, repair, storage and/or distribution of products


and/or ingredients of firearms, gunpowder and all those
indicated in E O 95.s 2002 Foreign Investment Negative list.

f)

Government Agency
Civil Aeronautics Board
Bangko Sentral ng Pilipinas

Philippine National Police

Department of National Defense

List of names and addresses of the present members of its Board of Directors
g) The board resolution, duly certified by the Cooperative Secretary, approving the Collection Agency Agreement (CAA) and
particularly naming the officer as the authorized signatory thereto.
h) Audited Financial Statements for the last three (3) years
i) Names and addresses of accountable officers to be bonded, and the estimated amount of coverage of the bond
j) Proposed nature of the bond to secure its performance under the CAA, and the estimated amount of

coverage of the bond.


k) List of all cooperative creditors and their addresses and the corresponding nature, amount and terms of obligations
l) Cerificate of Compliance issued by SSS
m) List of members who are Self- Employed or Voluntary Members of the SSS and their Corresponding Social Security
number, and individual statement allowing the cooperative to collect and remit their contributions to the SSS.

REMINDERS
1.
2.

Members of the cooperative who are self-employed members must be duly registered as such and must have submitted the
required registration form.
Members of the cooperative who are voluntary members should have been previously covered by the SSS as Employed,
Self-Employed, Overseas Filipino Worker or Non-Working spouse members. Otherwise, these members should register as
Self-Employed members.
CATEGORIES OF COOPERATIVES
Primary - the members of which are natural persons of legal age.
Secondary - the members of which are primaries.
Tertiary - the members of which are secondaries upward to one (1) or more apex organizations.

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