LAND BANK OF THE PHILIPPINES

Quezon Lending Center

Lucena City

CHECKLIST OF REQUIREMENTS FOR FINANCIAL ASSISTANCE

FOR COOPERATIVES
BOD Resolution requesting for financial assistance indicating the project and amount needed
with authorized signatories to transact with LBP
Application for financial assistance (form attached)
Annex A - List of updated set of officers and staff
Annex B - Schedule of Salaries & Honorarium
Annex C - Schedule of Loan Products
Annex D - Schedule of top ten shareholders
Annex E - Other information
Annex F - Masterlist of Members
Annex G - Schedule of Patronage Refund & Interest on Share Capital
Audited Financial Statements 2016-2018
Business Permit 2019
Surety bond of accountable officers 2019
Certificate of Good Standing from CDA 2019
Action Plan 2019
Medium term - development plan (3 to 5 years)
Amended Articles of Cooperation and By-laws (if any)
Duly filled-up customer information sheet for institutional customer (for the coop)
Duly filled-up customer information sheet (CIS) / biodata of board of directors, management team
with TIN No, picture and photocopies of valid identification cards; and
Cooperative Profile as of Dec. 31, 2018 with attached certifications
ABC MPC ANNEX A
Gumaca, Quezon PAGE 1 OF 2

LIST OF OFFICERS AND STAFF

As of Dec. 31, 2018
FULL NAME POSITION CIVIL DATE OF BIRTH PLACE OF BIRTH COMPLETE ADDRESS

LAST, FIRST MIDDLE STATUS (mm/dd/yyyy)

Prepared / Certified correct by:

Bookkeeper
 ANNEX A
PAGE 2 OF 2

EMAIL ADDRESS No. of TIN NO. CONTACT NUMBERS MOTHER'S

Educational Years in
Attainment coop MOBILE RESIDENTIAL MAIDEN NAME

Noted and Approved by:

Manager
ABC MPC ANNEX B
Gumaca, Quezon

SCHEDULE OF SALARIES/HONORARIUM AND LOANS

As of Dec. 31, 2018
NAME POSITION MONTHLY SALARY/ AMOUNT OF LOAN OUTSTANDING LOAN PURPOSE STATUS
HONORARIUM TO COOP BALANCE
BOARD OF DIRECTORS:

CREDIT COMMITTEE:

AUDIT & INVENTORY COMMITTEE:

ELECTION COMMITTEE:
STAFF

Prepared / Certified correct by: Noted and Approved by:

Bookkeeper Manager
ABC MPC
Gumaca, Quezon

SCHEDULE OF LOAN PRODUCTS OFFERED

As of Dec. 31, 2018
Rate for
Maximum Loan Retention /
Type of Loan Term of Loan Interest Rate per Annum
Loanable Basis of Loanable Add'l. Share
Amount Amount capital

Prepared / Certified correct by: Noted and Approved by:

Bookkeeper Manager
ANNEX C

Special privileges for

oustanding members, if
any
ABC MPC
Gumaca, Quezon

TOP TEN SHAREHOLDERS

As of Dec. 31, 2018
FULL NAME BIRTHDATE/BIRTHPLACE COMPLETE ADDRESS Educational TIN NO.
Attainment

Prepared / Certified correct by: Noted and Approved by:

____________________ ____________________
Bookkeeper Manager
ANNEX D

Amount of
Subscribed Capital Paid-up
ABC MPC ANNEX E
Gumaca, Quezon

OTHER INFORMATION

STRENGTHS OF THE COOP (good points that make the coop stand-out from other
coops/financing institutions)
ex. quality service extended to members thru giving benefits like…
promotional activities undertaken if any
expected new members to join the coop

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

RISK AREAS (problems that coop encounters or may encounter and how do the coop resolve the issues)
ex. competition.

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Prepared / Certified correct by: Noted/Approved by:

____________________ __________________________
ABCABC MPC
GumaGumaca, Quezon

MASTERLIST OF MEMBERS
For the years 2017 to 2018

Share Capital Increase/D Savings Deposit

Name
2017 2018 ecrease 2017
1
2
3
4
5
6
7
8
9
10
11
12
13
14

TOTAL

Prepared by: Certified correct by:

Bookkeeper Treasurer
Savings Deposit Increase/D
2018 ecrease

Noted by:

Manager
ABC MPC
Gumaca, Quezon

SCHEDULE OF PATRONAGE REFUND AND INTEREST ON SHARE CAPITAL

For the years 2016 to 2018

Years Patronage Refund Int. on Share Capital Total

2016
2017
2018
TOTAL

Prepared by: Noted by:

Bookkeeper Manager
Certified correct by: Noted by:

Treasurer Manager