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NGO Application Form

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Republic of the Philippines

Province of Ilocos Sur

CITY OF VIGAN

APPLICATION FORM FOR ACCREDITATION OF NON GOVERNMENT ORGANIZATIONS (NGO)

(Section 108 of Republic Act 7160; Article B, Chapter VII of Ord. No. 20, S. 2014)

New

                                                                                                                       

Name of Organization: __________________________________________________________

Address: ______________________________________________________________________            

Telephone/Contact No.: _________________________________________________________            

Date Organized:____________________________ Date Registered:______________________

Registering Agency: (Please check the appropriate box)

            (           )           Securities and Exchange Commission (SEC)

            (           )           Cooperatives and Development Authority (CDA)

            (           )           Department of Labor and Employment (DOLE)

            (           )           Department of Social Welfare and Development (DSWD)

            (           )           Others (Please Specify) ________________________________________

NGO Organization Level: (Please Check applicable box)

            (           )           Barangay/Community Based

            (           )           Chapter

            (           )           Affiliate of larger NGO: _________________________________________

            (           )           Others (Specify):______________________________________________

Sectors Represented: (Please check one (1):

            (           ) Business Sector                     (           ) Persons with Disability

            (           ) Social/Cultural Devt.                        (           ) Academe/Education

            (           ) Cooperatives                         (           ) Transport/PUV Drivers/Operators

            (           ) Professional                          (           ) Charitable/Socio-Civic

            (           ) Women                                 (           ) Senior Citizens

            (           ) Youth/Children/Sports          (           ) Religious

            (           ) Health and Sanitation           (           ) Social Justice/Peace & Order

            (           ) Others (Specify)

Total Number of Members:  ______ Male                         _______Female          _______Total

Names of Officers and Members of its Board of Directors:

  

                           Name                                                                      Position

Purposes/Objectives (Please Use Additional Sheet if Necessary)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Services/Facilities the Organization can provide or participate in.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ACCOMPLISHMENTS (Previous Year)

PROJECTS

COST

BENEFICIARIES

STATUS

       
       
       
       
       
       
       
       
       
       
       
       
       
       

SOURCE OF PROJECT FINANCING:

(           ) Membership Dues                (           ) Fund Raising                         (           ) Foreign Donation

(           ) Local Grant                           (           ) Foreign Grant          

(           ) Others (Pls specify):___________________________________________________

Linkages ( check level and specify)

            (           ) International   ________________________________________________

            (           ) National         ________________________________________________

            (           ) Regional         ________________________________________________

            (           ) Provincial      ________________________________________________

We hereby Certify to the correctness of the above-mentioned information.

                                                                        __________________________________________

                                                                                   (PRINTED NAME AND SIGNATURE)

                                                                                         Secretary of the Organization

Attested:

________________________________________________

               (PRINTED NAME AND SIGNATURE)

                   President of the Organization

Date of Submission: _______________________________________