(PDP

L A BA N )

APPLICATION FOR MEMBERSHIP

Please submit
two copies of
your 1x1 ID

AND ASSOCIATE DATA SHEET

picture.

Please write down clearly. Mark appropriate boxes with or .

ID Number (O.R. Number)

Date of BMS

First Name

Middle Name

Nickname

Telephone Number

Gender

Place of BMS
Last Name
Cell Phone Number

Civil Status

City / Municipality

Educational Attainment

Email Address

Name of Spouse, if married

Male

Age
Date of Birth
Place of Birth
Female
House No. / Lot No. / Block
Street / Purok No.
No.
Barangay

Suffix

Religion
Subdivision / Sitio /

Province

Neighborhood

District

Profession / Occupation / Sector

Name of School/Level/Degree: Elected Official/Position:_____________________

Govt Employee
Year Graduated:

Entrepreneur

Cooperative / NGO

Self-

employed
Private Employee

Unemployed

Other:_______________
Membership/Involvement/Employment with other Organizations/Companies/Agencies

Organization / Company /
Agency

Designation

Year Joined / Term

2440-B 2ND FLOOR, F.B. HARRISON ST. CORNER PALM COURT, PASAY CITY
(02)264-6111 pdplaban.pasaynhq@gmail.com

partidoPDPLABAN

(PDP

L A BA N )

Person to be notified in case of emergency

Contract Number

___________________________________________________
Name of Member & Signature

Recruited by:

BMS Conducted by:

One Time

Database Entry

Membership Fee
Amount Paid:

Encoder:

___________________

___________________

_________

_________

(Please sign over

Chapter

Party Trainor

printed name)

Head/Coordinator

(Please sign over

(Please sign over

printed name)

O.R. No.

Date Issued

Date:

printed name)

2440-B 2ND FLOOR, F.B. HARRISON ST. CORNER PALM COURT, PASAY CITY
(02)264-6111 pdplaban.pasaynhq@gmail.com

partidoPDPLABAN

(PDP

L A BA N )

PANUNUMPA

Ako,

si

__________________________

_________________________________________nanggap

ng
bilang

kasapi

lungsod
ng

DEMOKRATIKO PILIPINO LAKAS NG BAYAN (PDP LABAN) ay sumusumpa na:

itataguyod ko ang Saligang Batas ng Partido na kung saan

nakalahad ang aking paniniwala at paninindigan para sa
Kalayaan, Pagkakaisa, Katarungan, Pagkakapantay-pantay at
Pananagutang Panlipunan, Kasarinlan, Mabisang Pagkilos,
Pagkamakabayan at Pederalismo;

susundin ko ang mga alituntunin at patakarang ipatutupad ng

mga kinauukulang pamunuan ng Partido;

itataguyod ko at makikiisa sa mga pagkilos ng Partido;

iaalay ko ang aking sarili sa masalimuot ngunit kinakailangang

tungkulin para sa ikauunlad ng bawat mamamayang Pilipino at sa
Kalayaan ng Bayan.

Lahat ng ito ay aking tinatanggap ng kusang-loob at walang pasubali.

KASIHAN NAWA AKO NG MAYKAPAL.
Nilagdaan ngayong ika-_____ ng ______________________________ taon _____.

2440-B 2ND FLOOR, F.B. HARRISON ST. CORNER PALM COURT, PASAY CITY
(02)264-6111 pdplaban.pasaynhq@gmail.com

partidoPDPLABAN

ng
PARTIDO

(PDP

L A BA N )

_________________________
Lagda ng Kasapi
Pinagtibay:

_________________________
Lagda ng Pinuno

2440-B 2ND FLOOR, F.B. HARRISON ST. CORNER PALM COURT, PASAY CITY
(02)264-6111 pdplaban.pasaynhq@gmail.com

partidoPDPLABAN