Terms & Conditions
In compliance with the Data Privacy Act (DPA) of 2012 and its Implementing Rules and Regulations, I agree and authorize Barangka Credit Cooperative (BCC), a primary multi-purpose cooperative registered under the Cooperative Development Authority (CDA), to use my Personal Information to process any transaction related in the availment of Barangka Credit Cooperative's Products and Services, including the insurance services and administer the benefits as stated in the policy and other service agreements and inform me of future customer campaigns and base its offer using the personal information I shared with the company. *
*Click/tap here to read full BCC's Data Privacy Consent .
Please click/tap the checkboxes to proceed with your application.
Common Share Capital Subscription Agreement
Term of Subscription
24 Months
23 Months
22 Months
21 Months
20 Months
19 Months
18 Months
17 Months
16 Months
15 Months
14 Months
13 Months
12 Months
11 Months
10 Months
9 Months
8 Months
7 Months
6 Months
5 Months
4 Months
3 Months
2 Months
1 Month
Term of Payment
Weekly
Semi-Monthly
Monthly
Others
First Payment Date
Last Payment Date
Mode of Payment
Over the Counter (OTC)
Payment thru banks
Post Dated Checks
Debit from ATM/ Salary
Debit from regular savings.
Pledge Every
Daily
Weekly
Semi-Monthly
Monthly
Share Capital Account Pledge
Regular Savings Account Pledge
Personal Information Kindly fill in the needed information below.
Last Name
First Name
Middle Name
Nickname/Alyas
Present Address
Street & Subdivision/Barangay
City/Province
Type of Ownership
Owned
Rented
Mortgage
Free Use (Libreng Paninirahan)
Length of Residency (Years)
Length of Residency (Month/s)
*If Free use, owned by:
Provincial Address
Street & Subdivision/Barangay
City/Municipality/ Province
My Permanent Address (Same)
Permanent Address
Street & Subdivision/Barangay
City/Municipality/ Province
Date of Birth
Age
Place of Birth
Educational Attainment
College Graduate
Post Graduate
Vocational Degree
High School Graduate
Elementary Graduate
Atbp.
Civil Status
Single
Widow/Widower
Married
Legally Separated
Telephone No.
Mobile Phone No.
*If Post Graduate, choose below:
*If atbp., please indicate in the box
*If married, Anniversary Date
SSS/GSIS No.
TIN No.
Email Address
FB Account URL
PSN (Person with Special Needs)
PSN No. (If Yes, ID No.)
Affiliation/Civic Organization Membership
Position
Name of Organization
Your Mother's Full Maiden Name
Last Name (MFMN)
First Name (MFMN)
Middle Name (MFMN)
Character References (not related to you)
Name
Contact No.
Name
Contact No.
Requirements:
Specimen Signature
Digital Picture (Face)
Life Share Protection Program Beneficiaries Kindly fill in the needed information below.
Secondary Beneficiaries
Surviving Surviving Parents, Surviving Siblings, Surviving Nephews & Nieces)(Based on your declared civil status)
Primary Beneficiaries
Surviving Legal Spouse, Surviving Legal Children(Based on your declared civil status)
No. 1 - Relationship
Please select
Parents
Siblings
Nephews
Nieces
Common law
Children/Child
No. 1 - Full Name
No. 1 - Date of Birth
No. 1 - Gender
Please select
Male
Female
No. 1 - Civil Status
Please select
Single
Legal Separated
Widow/Widower
Married
No. 1 - Contact No.
No. 1 - Relationship
Please select
Legal Spouse
Legal Children
No. 1 - Full Name
No. 1 - Date of Birth
No. 1 - Gender
Please select
Male
Female
No. 1 - Civil Status
Please select
Single
Legal Separated
Widow/Widower
Married
No. 1 - Contact No.
Hidden Label (Item #85)
Hidden Label (Item #85)
No. 2 - Relationship
Please select
Parents
Siblings
Nephews
Nieces
Common law
Children/Child
No. 2 - Full Name
No. 2 - Date of Birth
No. 2 - Gender
Please select
Male
Female
No. 2 - Civil Status
Please select
Single
Legal Separated
Widow/Widower
Married
No. 2 - Contact No.
No. 2 - Relationship
Please select
Legal Spouse
Legal Children
No. 2 - Full Name
No. 2 - Date of Birth
No. 2 - Gender
Please select
Male
Female
No. 2 - Civil Status
Please select
Single
Legal Separated
Widow/Widower
Married
No. 2 - Contact No.
Hidden Label (Item #116)
Hidden Label (Item #93)
No. 3 - Relationship
Please select
Parents
Siblings
Nephews
Nieces
Common law
Children/Child
No. 3 - Full Name
No. 3 - Date of Birth
No. 3 - Gender
Please select
Male
Female
No. 3 - Civil Status
Please select
Single
Legal Separated
Widow/Widower
Married
No. 3 - Contact No.
No. 3 - Relationship
Please select
Legal Spouse
Legal Children
No. 3 - Full Name
No. 3 - Date of Birth
No. 3 - Gender
Please select
Male
Female
No. 3 - Civil Status
Please select
Single
Legal Separated
Widow/Widower
Married
No. 3 - Contact No.
For Common law (additional requirements)
No Legal Impediment (7 Years Cohabiting) CENOMAR (Per Individual) Affidavit of Cohabitation
*Acceptable file formats are JPG, PNG and PDF with total maximum size of 10 MB. *Try this tool to compress images to a smaller file size.
CENOMAR (For Male)
CENOMAR (For Female)
Affidavit of Cohabitation
Financial Information Kindly fill in the needed information below.
Current Source of Income
Employed
Self-Employed
Retired
Housewife
Student
Others
*If others, please type here.
Company/ Business Name
Position
Years of Operations/ in Service
Company/ Business Contact No.
If others (Status)
Company/ Business Address
Building/House No.
Street
Subdivision/Barangay
City/Municipal/ Province
Date Started
Estimated Monthly Income
Below 15,000
15,000/ to 30,000
30,000/ to 50,000
50,000/ to 80,000
Above 80,000
Other Source of Income
Monthly Income
Please select
Below 15,000
15,000/ to 30,000
30,000/ to 50,000
50,000/ to 80,000
Above 80,000
Referred by
Tracking Application No.
Submit
