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Cooperative Accreditation Form
SSS application form for Cooperative Accreditation
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: 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
NAME OF COOPERATIVE
EMPLOYER ID NUMBER
PRINCIPAL OFFICE ADDRESS
(Room/Floor/Bldg No./Name)
(Street)
(Subdivision/Village)
(Barangay/District/Locality)
(City/Municipality)
(Province)
START OF OPERATION
(mm/dd/yyyy)
POSTAL CODE
NUMBER OF MEMBERS AREAS OF OPERATION:
TYPE OF COOPERATIVE:
CREDIT
CONSUMERS
PRODUCERS
SERVICE
MULTI PURPOSE
MARKETING
TELEPHONE NUMBER
(AREA CODE)
FAX NUMBER
(AREA CODE)
OTHERS: (Specify)
E-MAIL ADDRESS
PART II - CERTIFICATION
I certify that the information provided in this form are true and correct.
SIGNATURE OVER PRINTED NAME
OFFICIAL DESIGNATION
DATE
PART III - TO BE FILLED OUT BY SSS
A. RECEIVING BRANCH
RECEIVED BY:
RECEIVING BRANCH
SIGNATURE OVER PRINTED NAME
TIME
DATE
SIGNATURE OVER PRINTED NAME
B. INVESTMENTS RESEARCH AND SUPPORT DEPARTMENT
CAPITALIZATION:
CURRENT RATIO:
3-YEAR PROFITABILITY NET INCOME (LOSS)
YEAR 2
YEAR 1
REVIEWED BY :
SIGNATURE OVER PRINTED NAME
REMARKS:
EVALUATED BY:
TIME
DATE
SIGNATURE OVER PRINTED NAME
CONFIRMED BY:
DATE
DATE
SIGNATURE OVER PRINTED NAME
C. MEMBERSHIP SECTION, DILIMAN BRANCH
DATE
DATA CONTROLLED BY:
ENCODED BY:
SIGNATURE OVER PRINTED NAME
QUICK RATIO:
YEAR 3
RECEIVED BY:
SIGNATURE OVER PRINTED NAME
REVIEWED BY:
DATE
DATE
SIGNATURE OVER PRINTED NAME
DATE
INTRUCTIONS
1. Fill out this form in two (2) copies and accomplish Parts I & II signed by the President/Chairman.
2. 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.
3. This application shall be submitted with the following documents:
a)
b)
c)
d)
e)
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
Land Transport
Construction of water transport/vessel
Operation of Radio,Television, telephone
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.
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.
Government Agency
Civil Aeronautics Board
Bangko Sentral ng Pilipinas
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 Transportation Franchising and Regulatory Board
Maritime Industry Authority
National Telecommunications Commision
Philippine Overseas Employment Administration
Philippine National Police
Philippine National Police
Department of National Defense
f) 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. Members of the cooperative who are self-employed members must be duly registered as such and must have submitted
the required registration form.
2. 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.
