TABLE OF CONTENTS CHAPTER 1. INTRODUCTION TO QUIDAN PAG-INUPDANAY MBA

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ABLE OF

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ONTENTS

CHAPTER 1. INTRODUCTION TO QUIDAN PAG-INUPDANAY MBA

SECTION 1. INSTITUTIONAL BACKGROUND SECTION 2. MISSION STATEMENT

SECTION 3. LEGAL AND ORGANIZATIONAL STRUCTURE SECTION 4. JOB DESCRIPTIONS

SECTION 5. FUNDING SOURCE AND INVESTMENT SECTION 6. MARKET AND CLIENTELE

SECTION 7. ENVIRONMENTAL FACTORS CHAPTER 2. OPERATING SYSTEMS AND PROCEDURES

SECTION 1. PRODUCTS, BENEFITS AND COVERAGE SECTION 2. OTHER BENEFITS

SECTION 3. INSURANCE TERM,CONTRIBUTION AND CERTIFICATION SECTION 4. PAYMENT PROCEDURES AND RECORD KEEPING

SECTION 5. CLAIMS PROCEDURES

SECTION 6. ENSURING INSTITUTIONAL EFFECTIVENESS CHAPTER 3. IMPACT TO CLIENTS

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CHAPTER 1: INTRODUCTION

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ECTION

1.

I

NSTITUTIONAL

B

ACKGROUND

Quidan Pag-inupdanay MBA is an association whose membership is comprised mainly of the poor women of the province of Negros Occidental. They are the beneficiaries of the micro finance program of Pag-inupdanay Incorporated (PI)– a province based MFI and Quidan Kaisahan (QK)– a local based non-government organization.

The micro insurance program was conceptualized by QK and PI in the course of their program implementation in addressing the persistent poverty situation of the province of Negros Occidental. Hardly hit of this situation are the marginalized sectors such as women, farm workers, small farmers, fisherfolks, etc. The two organizations implement several programs in the view of making the poor escape poverty and exploitation and making them masters of their own destinies. The MBA Program is seen as the arm that will help the poor mitigate risks affecting their lives, and in the process, provide them the social security they need.

Quidan Pag-inupdanay MBA started on September of 2005 under the supervision of Center for Agriculture and Rural Development- Mutual Benefit Associations (CARD MBA) through their Built and Operate Transfer Program (BOAT Program). The insurance package included Life Insurance, Loan Redemption Insurance and the Retirement Savings Fund. While providing these services to client members, CARD MBA also developed the technical capacity of Quidan Pag-inupdanay MBA in the management of association.

In 2009, a year later after the BOAT program of CARD MBA ended, Quidan Pag-inupdanay organized its own MBA implementing a micro insurance that is anchored in the real needs of its members. To date through the constant technical assistance of CARD MBA and its linkage with RIMANSI, the association is continuously providing social protection services to its 18,000 members.

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ECTION

2.

Q

UIDAN

P

AG

-

INUPDANAY

MBA

M

ISSION

S

TATEMENT

The association envisioned to develop a “ just, free and peaceful societies where there is equal access to opportunities; and where cultural identity and citizens’ honor are upheld; and respect for all creations promoted”.

The associations also shared goals with its partner institutions (PI and QK) in helping : a. build empowered communities that are able to respond to their economic, political

and cultural needs and concerns.

b. develop a critical mass that actively pursues the people’s rights and responsibilities for genuine and sustainable development.

Generally, it was formed to advance the interests and promote the welfare of the marginalized sector of the country, particularly the Province of Negros Occidental. Specifically, the objectives of the association are the following:

1. To extend financial assistance to its members, spouse, children and parents in the form of death benefits, sickness benefits and loan redemption assistance;

2. To facilitate the accumulation of member’s savings through its Retirement Savings Program; and,

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4 3. To ensure continued access to benefits/resources by actively involving the

members in the management of the association that will include implementation of policies and procedures geared toward sustainability and improved services.

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ECTION

3.

L

EGAL AND

O

RGANIZATIONAL

S

TRUCTURE

QUIDAN PAG-INUPDANAY MBA is registered with the Securities and Exchange Commission (SEC) and was licensed by the Office of the Insurance Commission (OIC) to operate as mutual benefit association on January 12, 2010. Majority of the members of the Board of Trustees has two-year term and minority has one-year term.

The Board of Trustees (BOT) is the policy making body of the association. It is the second highest governing body following the general assembly. The BOT is composed of seven (7) members. Five members of the BOT came and were elected by the general assembly and two are independent board which was nominated and confirmed by the assembly. One of the independent board came from the religious sector ( Bishop Gerardo Alminaza) and the other one came from the insurance company. Majority(4 out of 7)of the members of the BOT are women.

The BOT meet once a month. It has a chairman who acts as the President, a Secretary and a Treasurer.

Within the Board of Trustees, there are two (2) committees who perform major functions:

1. Oversight and Audit committee who monitors and evaluates the adequacy and effectiveness of the internal control system;

2. Nomination Committee who reviews and evaluates the qualifications of all persons nominated to the Board as well as those nominated to other positions requiring appointment by the Board of Trustees. The committee is also tasked to conduct and supervised the election of the Board of trustees and other officers proclaim the winners.

The association has 7 total workforce. It is headed by the Executive Director who acts as the general manager of the association. He is in-charge of the day to day operation and responsible for the implementation of the direction set by the Board of Trustees. Under the executive directors are the Officers of the following Division:

a. Underwriting Division: Responsible for the promotion, campaigns and conduct direct selling of all product lines of the Associations. The division is also in charge of the establishment and maintenance of the database of all members and their legal dependents. In coordination with claims

division, the division is also responsible for the posting of all claims made by the members. The division also track members with miss payment of premium.

b. Claims Settlement Division: Responsible in the maintenance of current, accurate and complete records of all claims transactions in accordance with the office policies, sound insurance practices and in conformity with Insurance Commission’s rule and regulations.

c. Accounting and Administrative Division is being lead by the Accountant who is in charge of the financial recording of all transactions of the association. The division is also in-charge of all administrative concerns. The division is being run by two full time staff. In coordination with the MIS in the underwriting division, all contributions made by the members are posted in the accounting division.

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5 The organizational structure of the association is illustrated below.

Figure 1. Organizational Structure

Board Of Trustees President

Executive Director

Claims & Documentation Officer Underwriting Officer MBA Coordinators Chief Accountant MIS Officer Encoder Finance Asst. Bookkee per

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OB

D

ESCRIPTIONS

1. Executive Director/General Manager

General Duties and Responsibilities

:

Plans, organizes, directs, coordinates, monitor, controls and evaluates the marketing and underwriting as well as claim adjustment activities of the association.

Report directly to the President of the Associations.

Specific Duties and Responsibilities

:

A. Related to Operation:

1. Directs and supervises the implementation of the approved plans, programs, projects and policies of the association;

2. Directs, supervises, and controls the issuance of Certificates of membership; 3. Directs, supervises and coordinates marketing and promotional activities

subject to the approved plans and programs;

4. Develop, innovates and formulate policies for the consideration of the Board of Trustees to ensure smooth implementation of the plans and programs of the Association;

5. Exercises over-all supervision over the underwriting of life and non-life insurance policies and ensure that all underwriting transactions are in accordance with the policies of the Association, sound insurance practices

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6 and in accordance with the regulations of the Office of the Insurance

Commission;

6. Monitors, controls and evaluates the collections and remittance of member’s contributions and maintenance of accurate records of all underwriting

transaction in the prescribe forms;

7. Monitor the maintenance of appropriate recording and filing system of all underwriting documents including the Master List of Members, List of recognized and registered members;

8. Monitors the recording, reporting and filing of all underwriting and claims documents;

9. Perform other related functions as may be assigned from time to time by the president of the Association.

B. Related to Administration and Finances:

1. Reviews and approves financial and other consolidated periodic reports; 2. Reviews and approves all vouchers for payment ;

3. Recommends to the Board of Trustees the hiring or promotion of all personnel and other personnel movement subject to the provisions of approved policies;

4. Exercise over all supervision of personnel and ensure cleanliness for the smooth operation of the Association.

C. RELATED TO COMPTROLLERSHIP

1) Establishes and maintains accounting systems consonant with the Association’s requirements, rules and regulations

2) Reviews and finalizes all financial statements of the Association.

3) Prepares the annual financial plan and expense budgetary programs and standards; oversees compliance to such programs and standards by the organizational units of the Association.

2. Promotion and Underwriting Officer

General Duties and Responsibilities:

Promotes, campaigns and conducts direct selling of all product lines of the Association to Cooperatives, microfinance institutions and other people’s

organizations.

Directly responsible in supervising and controlling the issuance of insurance policies (Certificate of Membership), maintenance of current, accurate and complete records of all insurance transactions in accordance with the office policies, sound insurance practices and in conformity with Insurance Commission’s rules and regulations.

Specific Duties and responsibilities:

1. Undertake the marketing and underwriting activities of the association;

2. Assist the general manager in the product promotions and information dissemination activities;

3. Ensures the maintenance of appropriate recording and filing system of all documents including list of recognized and resigned members and the list of members under moratorium.

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7 4. Monitors the status of members under moratorium of all branches and advices

them before their period of moratorium expires.

5. Monitors the status of membership of each member and advices them before their insurance period of cover expires.

6. Supervises and controls the issuance of Certificates of Membership.

7. In coordination with the MIS, verifies accuracy of status reports and accuracy and submit the same to the general manager;

8. Develop innovative marketing techniques and selling strategies to reach out the untapped target market.

9. Provide technical support to MFI branch managers and program officers by conducting regular cliniquing on micro insurance implementation.

10.Directly responsible for the elections and development of MBA coordinators; 11.Performs such other functions as may be assigned by the Manager.

Other Functions:

i) Reviews and recommends financial transactions for approval by the general manager;

ii) Acts as liaison officer with RIMANSI;

iii) Supervise the management information system of the associations MIS Related Functions

1. Provides management with the necessary reporting system that would translate the daily activities of the Association into quantitative transactions.

2. Reviews periodic reports using computer programs / systems before submission to the management.

3. Directs and controls the efficient and timely issuance of Sertipiko ng Pagiging Kasapi in coordination with the Head of Underwriting and Promotion Officer. 4. Makes necessary recommendations for the revision of existing system/s to

comply with the demands of time.

5. Recommends equipment necessary for the enhancement of existing programs /systems.

6. Spearhead the encoding of member’s premium and reconcile the same with the bookkeeper;

7. Performs other functions as may be assigned by the MBA Manager/ Head of the Underwriting and Promotion.

3. Claims Settlement Head

Primary Duties and responsibilities

Performs or conducts independent investigation of claims for indemnity filed by assured members or their beneficiaries; determines the appropriate amount of indemnity and initiates settlement of such claims in coordination with the Board of Awards, MBA Coordinators and concerned Branch Managers.

Specific Duties and responsibilities

1. Conducts necessary investigations, validations and evaluations of claims for indemnity filed by assured members or their beneficiaries thru the Board of Awards, MBA Coordinators and concerned Branch Managers.

2. Ascertains and verifies claimant’s identity and insurable interest in accordance with the set policies of the Association.

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8 3. Processes and maintains files of paid claims document submitted by the MBA Coordinators, lending institutions and other intermediaries authorized to do business in behalf of the Association including other records related to the function. And if needed, requires the immediate submission of necessary documents in conformity with the Association’s rules and regulations.

4. Submits written report the results of claims investigation, evaluation and regular audit of claims documents to the Claims Settlement Officer with appropriate recommendation or actions to be taken.

5. Maintains the underwriting documents of non-PI members submitted by the MBA Coordinators, lending institutions and other intermediaries authorized to do business in behalf of the Association.

6. Attends meetings related to the Association as instructed by the MBA Manager and/or Claims Settlement Officer.

7. Performs such other functions as may be assigned by the MBA Manager and/or Claims Settlement Officer.

8. Maintains updated Individual Ledger Card, filing of Collection Schedules and follow-up unsubmitted documents of non-PI members.

4. Chief Accountant

General Duties and Responsibilities

Assists the General Manager in ensuring care and protection over the Association’s resources and staff for productivity and efficiency.

Act as Admin and Finance Head

Specific Duties and Responsibilities

1. Coordinates with regulatory agencies to ensure that the Association conforms to the rules and regulations required by law;

2. Directly responsible in efficient handling of the Association’s personnel records; 3. Ensures that all personnel are covered with the existing personnel maintenance

program as mandated by Philippine Government;

4. Supervises daily maintenance and security of Association’s properties and facilities;

5. Recommends repairs and improvement of equipment and facilities necessary for productivity and efficiency of day-to-day operations;

6. Prepares and submits bi-monthly staff payroll and effect payment accordingly; 7. Maintains complete and updated records of staff gross compensation;

8. Maintains complete and updated records of properties and equipment; 9. Prepares and submits periodic reports on properties and equipment;

10.Facilitates remittances to SSS and BIR and to all other regulatory agencies all dues in conformity with the existing laws.

11.Directly responsible for bidding, obtaining quotations and causes the preparations of purchase orders;

12.Issues trip tickets and gate passes;

13.Performs such other functions as may be assigned by the MBA Manager. Other functions:

1. In coordination with the finance unit, monitor excess fund of the association; and 2. Recommends the placement of excess funds of the Association in high yielding

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9 5. Admin Assistanct/ Acting Cashier

1. Keeps custody of all moneys, securities and documents of value to the Association and deposit these with duly-authorized banking institutions and depositories designated by the Management.

2. Effects payment of all financial obligations of the Association on the basis of duly-approved voucher and other basis of payment authorization; and

3. Performs other related functions as may be assigned from time to time by the Chief Accountant.

4. Acts as Petty Cash Custodian and perform the following based on the approved association’s policy:

(1)Disburse petty cash fund as approved by the cashier based on the existing policy;

(2)Prepares petty cash liquidations. (3)Request petty cash replenishment. 6. Bookkeeper

General Duties and Responsibilities

Provides the management with timely and accurate financial information together with the results of the Association’s monthly financial operations.

Specific duties and Responsibilities

1. Coordinates with concerned regulatory agencies to ensure compliance to the institutional rules and regulations required by law such as monthly remittances to BIR, SSS (contributions and loans), Philhealth and HDMF (contributions and loans).

2. Keeps control of all accountable forms.

3. Prepares and submits bi-monthly staff payroll and effects payment accordingly. 4. Prepares check voucher /cash voucher for disbursement.

5. Prepares general voucher periodically.

6. Prepares daily compound transactions summary of receipts , disbursements and general journals.

7. Daily posting to the Subsidiary Ledger and General Ledger per account. 8. Prepares and submits monthly required reports.

9. Performs other functions as may be assigned by the MBA Manager. 7. MIS ENCODER

Reports Directly to the Underwriting Officer

Maintains and updates accurate membership data and their corresponding contributions.

Specific Functions:With the MUnCET:

1. Encode all recognized members, date of recognition, their legal dependents and all pertinent data required by the system;

2. Update all active members by encoding resigned members every month; 3. Coordinates with the branch manager through his/her direct supervisor all un

reconcile membership information

4. Print and control all membership certificate for distribution to branches 5. Submit monthly reports to underwriting head

6. Reconcile data with all MFI branches on the number of active members 7. Perform other functions as assigned by the direct supervisor.

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8.MBACOORDINATORS

ELIGIBILITY:

1. 18 years old and above and willing to take the responsibility of an MBA Coordinator.

2. Active member and with good record with CARD MBA or with its affiliates. 3. With on-going project financed by CARD, Inc. or CARD MBA’s affiliates. 4. No administrative or criminal case.

GENERAL DUTIES AND RESPONSIBILITIES:

1. Visits her branch once week on a designated day to confer with the branch staff and members on all matters pertaining to CARD MBA.

2. Validates claim for indemnity and all its supporting documents such as Marriage Contract, Birth Certificate, Death Certificate or Doctor ‘s Certificate on Total & Permanent Disability and Center’s Resolution.

3. Assists member-claimant / beneficiary in securing supporting documents to facilitate claims settlement to include networking with other MBA Coordinators in securing necessary documents.

4. Visits at least four (4) centers every month to gather feedback and/or suggestions on how to improve CARD MBA services, its product packages and other information related to the CARD Mutually Reinforcing Institutions.

5. Submits MBA Coordinator’s Monthly Report which includes total number of members of her Branch, claims paid for the month and all information gathered during her branch and centers visitations.

TERM OF OFFICE OF AN MBACOORDINATOR

An MBA Coordinator shall be elected among MBA Coordinators of each branch and shall hold office for one (1) year or until her successor is duly elected and qualified. SECTION 5. FUNDING SOURCE AND INVESTMENT

Funding of Quidan Pag-inupdanay MBA will be sourced out from the contribution of all members. Each member shall contributes Php 25.00 per week y (Php 20.00 for Life Insurance and Php 5.00 for their Provident/ Retirement Savings) to the Association. Aside from the weekly contributions, other source of fund of the Association is the 1.5% loan redemption fees being deducted from the proceeds of loan under its All Loans Insurance Package program.

One Hundred percent (100%) of members contribution for Retirement and Savings Fund and 50% of the contribution for Life insurance shall be set aside by the association as Reserve and should be recorded separately. The remaining fund contributed by the members should be the source of fund for the claims payment , admin cost and for the additional equity of the association. The fund of the association should be utilized based on the policy set by the insurance commission.

Reserves and other excess fund of the association should be invested in a more safest investment instruments as prescribed by the insurance commission. Preferably the association will invest its fund to government any treasury bonds and other instrument as approved by the regulating agency. .

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ECTION

6.

M

ARKET AND

C

LIENTELE

The Quidan Pag-inupdanay Mutual Benefit Association (QPI-MBA) is the insurance arm of the Quidan Mutually Reinforcing Institutions (Quidan-MRI)s. Ninety-eight (98%) of the CARD’s membership is women belonging to socio-economically disadvantaged sectors. The client-members of the Association are the members of Quidan Kaiashan and Pag-inupdanay, Inc., which essentially is a captured market. Pag-inupdanay targets landless women who have monthly per capita income of Php 1,500.00 and below. The cut-off used by PI in terms of marketable household assets to qualify with its lending program is Php 150,000.00, which is consistent with the capital limit in order to be included in the microfinance market as specified in RA 8425, otherwise known as a Poverty Alleviation Act. Members of Quidan Kaiashan and Pag-inupdanay, Inc. are automatically enrolled with QPI MBA.

MBA Coordinators, whose main function is claims’ validation, are assigned in each branch where PI operates (Figure 1). It is also through these Coordinators where feedback from the members at the center level is channeled. The MBA Coordinator, who is also a member-borrower of PI or QK, coordinates with the Center Chiefs and Branch Managers in terms of claims’ validation and reports needed by the MBA head office.

The links from top-to-bottom and bottom-to-top allow for the timely settlement of claims and high quality feedback mechanism. Before any new product or innovations are introduced to members, such mechanism is used to guarantee wide acceptance among members of any changes in the Association’s products and services.

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NVIRONMENTAL

F

ACTORS

Direct competition for membership in the micro-insurance market is virtually nil in areas where Quidan Pag-inupdanay operates. But there are several indirect competitors because commercial insurance companies develop products suited for the clients of microfinance industry. They are considered as indirect competitors in the sense that ownership of the microinsurance program still belongs to the insurance companies unlike the MBA where the ownership belongs to the active members of the Association.

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C

HAPTER

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O

PERATING

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YSTEMS AND

P

ROCEDURES

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ECTION

1.

P

RODUCTS

,

B

ENEFITS AND

C

OVERAGE

The QPI MBA provides a micro insurance program for the poor. It has the following product and services for the members:

1.1 LIFE INSURANCE PROGRAM

Upon payment of the first weekly contribution, a member and her legal dependents have life insurance coverage, the amount of which depends on the length of her membership. The legal dependents of a legally married member are the following:

a. her legal spouse;

b. her legal children who are single and below 21 years old;

c. her legal children who are single and more 21 years old but disable; d. her legally adopted children.

If a member is single, her legal dependents are her parents 60 years old and above.

In case of death of the member or any of her legal dependent, the beneficiary will be indemnified, the amount of which depends on her length of membership to Association and is shown in the table below.

Table 1 – Life Insurance Benefit

1.1.1 TOTAL AND PERMANENT DISABILITY (TPD) COVER - There are two causes of TPD under this program:

1.1.1.1. Due to accident resulting to:

a. Loss of both sight; c. Loss of both hands;

b. Loss of both feet; d. Loss of one foot and one hand.

This type of TPD can be settled immediately upon submission of complete claims documents.

1.1.1.2. Due to sickness/disease or accident – If a member or her legal dependent become sick resulting to complete inability of a member or her legal dependent to engage in any gainful employment and

TABLE OF LIFE INSURANCE BENEFITS (in Philippine Peso)

LENGTH OF CONTINUOUS MEMBERSHIP

CAUSE OF DEATH OR

TOTAL AND PERMANENT DISABILITY MEMBER

LEGAL DEPEND

ENTS LESS THAN 6

MONTHS

Due to Natural Death 2,500.00 NONE Due to Accident 10,000.00 5,000.00 6 MONTHS BUT

LESS THAN 12 MONTHS

Due to Natural Death 5,000.00 2,000.00 Due to Accident 10,000.00 5,000.00 12 MONTHS BUT

LESS THAN 24 MONTHS

Due to Natural Death 15,000.00 5,000.00 Due to Accident 30,000.00 10,000.00 24 MONTHS OR

MORE

Due to Natural Death 50,000.00 10,000.00 Due to Accident 100,000.00 20,000.00

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13 becomes bedridden or met an accident without dismemberment resulting to complete inability of a member or her legal dependent to engage in any gainful employment and becomes bedridden, they can be considered as total and permanently disabled if after six (6) months their health condition has not improve. After such confirmation, they will receive the monthly benefits as shown in Table of Monthly Benefits for Total and Permanent Disability.

If a member and/or her legal dependents have availed of benefits under the total and permanent disability (TPD) provision, she and/or her legal dependents can no longer avail of death benefits in case the disable dies, except for the balance of her or her legal dependents’ monthly benefits as specified in the Table of Monthly Benefits for TPD.

Table 2: Monthly Benefit for TPD

HALAGA NG BUWANANG BENEPISYO PARA SA TOTAL AT PERMANENTENG PAGKABALDADO

PARTIKULAR

KONTRI-BUSYON

HALAGA NG BUWANANG BENEPISYO

100,000.0 0 50,000.00 30,000.00 20,000.00 15,000.00 10,000.00 5,000.00 2,000.00 NOTICE OF TPD 80.00 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 OBSERVATION 400.00 27,780.00 13,890.00 8,335.00 5,555.00 4,415.00 2,780.00 1,390.00 555.00 TOTAL 480.00 33,336.00 16,668.00 10,002.00 6,666.00 5,248.00 3,336.00 1,668.00 666.00 NAIBAYAD NA KONTRIBUSYON** 480.00 480.00 480.00 480.00 480.00 480.00 480.00 450.00

TOTAL NA BENEPISYO MATAPOS

ANG ANIM NA BUWAN 33,816.00 17,148.00 10,482.00 7,146.00 5,728.00 3,696.00 2,148.00 666.00

BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,556.00 2,778.00 1,667.00 1,111.00 883.00 556.00 278.00 111.00 BUWANANG BENEPISYO 0 5,548.00 2,774.00 1,661.00 1,113.00 839.00 548.00 274.00 113.00 TOTAL NA BENEPISYO 100,480.0 0 50,480.00 30,480.00 20,480.00 15,480.00 10,480.00 5,480.00 2,000.00

** IRE-REFUND LAMANG KUNG ANG KASAPI ANG MAGIGING TOTAL AT PERMANENTENG BALDADO.

MOTOR VEHICLE ACCIDENTAL HOSPITALIZATION BENEFIT

In case an eligible member or the member’s legal spouse is hospitalized due to vehicular accident occurring after the date of membership and resulting in confinement for at least 24 hours for treatment by a qualified physician, the member will be reimbursed by QPI-MBA the actual medical expenses incurred within six (6) months from the date of accident for such treatment such as hospital charges and nurses fees up to a maximum of TEN

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14 THOUSAND PESOS (P10,000.00) per married couple. The MVAH benefit can only be availed of once during the lifetime of the member or the member’s spouse.

1.2 PROVIDENT FUND /RETIREMENT SAVINGS FUND

It is an administered fund intended for the retirement of members that can be availed of in lump sum at age 65. An active member pays her contributions until she reaches the retirement age of 65. These contributions are being invested in high yielding investment instruments to assure members of their retirement pay.

Depending on the entry age of a member in the QPI MBA, the Table of Benefits at Age 65 shows the accumulated fund at age 65 assuming default-free-contributions and the possible retirement funds allotted to the members. The exact amount of retirement fund depends on the investment income of the fund.

Table 3. Sample Computation of Benefits at Age 65 (Assuming the investment income is at 4.00 % per annum)

For example a member enrolled at the age of 30. Her total contribution from age 30 to 64 will be Php 8,440.00 but her benefits at the age 65 is Php 18,383.60 which can be used in any way she wants.

If a member decides to retire prior to age 65 (early retirement) and she has completed a minimum of two (2) years of continuous membership in the Association, a member shall be entitled to an equity value equivalent to 100% of the total contributions collected from her, plus regular savings interest and not the calculated amount of benefits at age 65 as stated in the table above.

A G E CONTRI- BUTION (Php BENEFIT AT AGE 65 (Php A G E CONTRI- BUTION (Php BENEFIT AT AGE 65 (Php A G E CONTRI- BUTION (Php BENEFIT AT AGE 65 (Php 18 11,280.00 33,183.17 34 7,440.00 14,808.35 50 3,600.00 4,997.89 19 11,040.00 31,666.89 35 7,200.00 13,998.80 51 3,360.00 4,565.66 20 10,800.00 30,208.94 36 6,960.00 13,220.39 52 3,120.00 4,150.06 21 10,560.00 28,807.05 37 6,720.00 12,471.91 53 2,880.00 3,750.44 22 10,320.00 27,459.09 38 6,480.00 11,752.22 54 2,640.00 3,366.19 23 10,080.00 26,162.97 39 6,240.00 11,060.21 55 2,400.00 2,996.72 24 9,840.00 24,916.70 40 6,000.00 10,394.82 56 2,160.00 2,641.47 25 9,600.00 23,718.37 41 5,760.00 9,755.02 57 1,920.00 2,299.87 26 9,360.00 22,566.12 42 5,520.00 9,139.83 58 1,680.00 1,971.41 27 9,120.00 21,458.20 43 5,280.00 8,548.29 59 1,440.00 1,655.59 28 8,880.00 20,392.88 44 5,040.00 7,979.51 60 1,200.00 1,351.91 29 8,640.00 19,368.54 45 4,800.00 7,432.61 61 960.00 1,059.92 30 8,400.00 18,383.60 46 4,560.00 6,906.74 62 720.00 779.15 31 8,160.00 17,436.53 47 4,320.00 6,401.10 63 480.00 509.18 32 7,920.00 16,525.90 48 4,080.00 5,914.90 64 240.00 249.60 33 7,680.00 15,650.29 49 3,840.00 5,447.40

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15 1.3 Loan Redemption Fund (LRF)

The LRF gives full loan protection to its member-borrowers and also to protect the QPI MBA’s accredited lending institutions by ensuring 100% collection of loans extended to the members in case of death. The ordinary LRF pays only the balance of the loan but with 1.5% of the principal amount of loan as contributions, the program pays the principal amount of loan of the dead member-borrower. Upon receipt and approval of due proof of death, CARD MBA will pay:

 the lending institution - the outstanding balance of loan at the time of death.

 her beneficiary - the paid portion of the loan at the time of death.

This is on top of the life insurance benefit that the beneficiary can get from the Life Insurance Program of QPI MBA.

S

ECTION

2.

O

THER

B

ENEFITS

MEMBER’S EQUITY VALUE

Upon termination of membership from QPI MBA, the member shall be entitled to an equity value equivalent to at least FIFTY PERCENT (50%) of all contributions made. A termination charge of not more than 50% of the total contributions collected from the member may however be imposed by QPI-MBA for terminations occurring in the first two years of membership. Interest shall be credited to the accumulated value every anniversary date at a rate to be determined by the Board of Trustees every year.

Upon reaching the termination age of 65, the member shall be entitled to payment of the member’s equity value. For unclaimed member’s equity value after reaching sixty-five, interest shall be credited to the equity value at a rate to be determined by the Board of Trustees but in no case less than 2% p.a. per year.

MASS WEDDING

Mass Wedding is another service that a member can avail of. It is intended for those members who are not legally married to their live-in partners with or without children. As provided for in the rules and regulations of our Life Insurance Program, only the member’s legal spouse and legitimate children will be considered as legal dependents. So, those members who are not legally married, their legal dependents are not their live-in partners and their children but their parents 60 years old and above.

However, we are advising all concerned members not to wait for the Convention to get married so that they can enjoy the full benefits that the QPI MBA can offer to its members. Through Mass Wedding ceremony, their live-in partners and children will become their legal dependents and can avail of all the benefits that the Association can give.

QPI MBA will shoulder all expenses related to documentary requirements of a mass wedding ceremony which is one of the highlights during a Pag-inupdanay Branch Convention.

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16

S

ECTION

3.

I

NSURANCE

T

ERM

,

C

ONTRIBUTION

&

C

ERTIFICATION

3.1. TERM OF INSURANCE

3.2. AMOUNT OF CONTRIBUTION

With Php 25.00 weekly contribution (Php 20.00 for LIFE and Php 5.00 for Retirement), the member and all her legal dependents (husband and children) have life insurance coverage the amount of which depends on the length of her membership.

In case of death of the member or any of her legal dependent, the beneficiary will be indemnified according to the table of QPI MBA Life Insurance Benefits.

3.3. CERTIFICATE OF MEMBERSHIP AS INSURANCE POLICY

The certificate of membership is not transferable. A sample of Certificate of Membership is presented in Chapter 4 as form QPI Form No. 2.

PAYMENT OF FIRST CONTRIBUTION PAYMENT OF PAYMENT OF FIRST CONTRIBUTION FIRST CONTRIBUTION RESIGNED TERMINATED RETIRED DEATH/TPD RESIGNED RESIGNED TERMINATED TERMINATED RETIRED RETIRED DEATH/TPD DEATH/TPD Sept. 4, 2002 Sept. 4, 2003 ANY EVE NT P RIOR TO THE EFF ECT IVITY OF INSURA NCE POL ICY IS NOT COV ERE D ANY EVE NT AF TER THE EFF ECT IVI TY OF INSURA NCE POL ICY IS NOT COV ERE D

TERM OF

INSURANCE

PAYMENT OF FIRST CONTRIBUTION PAYMENT OF PAYMENT OF FIRST CONTRIBUTION FIRST CONTRIBUTION RESIGNED TERMINATED RETIRED DEATH/TPD RESIGNED RESIGNED TERMINATED TERMINATED RETIRED RETIRED DEATH/TPD DEATH/TPD Sept. 4, 2002 Sept. 4, 2003 ANY EVE NT P RIOR TO THE EFF ECT IVITY OF INSURA NCE POL ICY IS NOT COV ERE D ANY EVE NT AF TER THE EFF ECT IVI TY OF INSURA NCE POL ICY IS NOT COV ERE D

TERM OF

INSURANCE

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17

S

ECTION

4.

P

AYMENT

P

ROCEDURES AND

R

ECORD

K

EEPING

3.1 IMPLEMENTING GUIDELINES ON REMITTANCE OF MBACONTRIBUTIONS

This shall cover remittance of members’ contributions for Life Insurance and Provident Fund; and fees for All Loans Insurance Package collected from member-borrowers.

A. Deposit Arrangement

1. The QPI MBA Head Office will maintain with the Bank of the Philippine Island (BPI) – Mandalagan Branch – Current Account No. 1391-0036-33

2. All remittances from the following branches of Pag-inupdanay, Inc. shall be deposited to BPI branch nearest to their respective location using the above-mentioned QPI MBA Current Account number.

B. Remittance Procedures

1. The Pag-inupdanay branch shall bring its monthly collections not later than the 7th day of each month to the local BPI branch or any designated depository bank for direct remittance or must be remitted directly to QPI MBA Head Office.

(In case the 7th of the month falls on a non-working holiday, all collections should be

remitted not later than the following working day.)

2. Pag-inupdanay branches shall immediately send to QPI MBA Head Office a copy of Schedule of remittance of MBA contributions and Summary of Loan Releases (if any) with the attached deposit slip.

C. Systems & Procedures of Remittances for PI Branches

Personnel Assigned Pag-inupdanay Branches QPI-MBA Office

Bookkeeper  Prepare schedule of

remittance at the end of every month using the format provided by QPI-MBA.

Branch Manager  Check and approve schedule

of remittance.

Cashier  Remit the corresponding

amount stated in the schedule of remittance (net remittance).

Cashier  Verify the remittance of PI Branch.

Issue Official receipt.

Bookkeeper  Prepare GV to record remittance

of PI Branch. Attach duplicate copy of deposit slip and schedule of remittance send by PI Branch.

Chief Accountant  Check GV and CM and its

attachments.

Executive Director  Approve GV and CM and its

attachments.

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18

S

ECTION

5.

C

LAIMS

P

ROCEDURES

5.1 SYSTEMS AND PROCEDURES IN PAYING CLAIMS FOR LIFE INSURANCE AND LOAN

REDEMPTION INSURANCE

OBJECTIVE: To decentralize and for uniformity of claims payment for Life Insurance And All Loans Insurance Package

RESPONSIBLE

PERSON A C T I O N

Upon member’s death,

her BENEFICIARY

1. Notifies the Center Chief and/or MBA Coordinator and/or the

Branch Manager of the death of member-borrower.

2. Accomplishes the Abiso ng Pagkamatay (MBA Form No. 07 or 09 or 8

whichever is applicable).

2.2.1. Physician’s Statement - to be filled up by attending

physician at the time of death.

2.2.2. Police Report, if the cause of death is due to accident or

murder.

3. Forwards all accomplished claim’s documents to the Center Chief.

CENTER CHIEF

4. Reviews all documents received.

5. Convenes the Board of Awards and takes appropriate action on the

case at hand.

6. If the request is meritorious, causes the preparation of Center’s

Resolution, which states the true cause of death and stating further that while still alive, the concerned member is active and pays her contributions on time.

7. Attaches Center Resolution to the accomplished MBA Form No. 07 or 09

and together with Physician’s Statement and Police Report if death is due to accident or murder.

8. Forwards all accomplished claims’ documents to the MBA Coordinator.

MBA

COORDINATOR

9. Validates the claim and its supporting documents.

10. Accomplishes MBA Form No. 07 B, 0r 07 C or 08

11. Forwards all accomplished documents such as MBA Form No. 07 or 09

or 08 to the Branch Manager. BRANCH MANAGER

12. Reviews all submitted documents and takes appropriate action.

13. Instructs the concerned Development Officer to accomplish Claims

Settlement Sheet for All Loans Insurance Package (MBA Form No. 10)

DEVELOPMENT OFFICER

14.Accomplishes MBA Form No. 10

15.Attaches Weekly Payment Schedule and copy of Promissory

Note/s.

16.Forwards accomplished MBA Form No. 10 together with its attachments

to the Branch Manager. BRANCH MANAGER

17. Reviews MBA Form No. 07 or 09 and 10, their attachments and takes appropriate action.

18. If approved, forwards the same to Bookkeeper for vouchers preparation.

RESPONSIBLE

PERSON A C T I O N

BOOKKEEPER

19.Prepares two vouchers cross referring to one another (one Cash or

cheque Voucher and one General Voucher with the following entries: Sample Cash or ChequeVoucher:

Cash or Cheque Voucher No. ____ Representing payment of LIFE INSURANCE benefits of Carmen Rosales who died on______ : (see Table of Benefit) Php 30,000.00 Representing payment of LRF under the All Loans

Insurance Package of Carmen Rosales on the paid portion of

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19

10,000.00 Total Php 40,000.00 COMPUTATION:

Total Amt. of Loans(Prin) – kabakod -Php 15,000.00

Payment made as of the time of death(Prin) = Php 10,000.00 (CV No. ____)

Balance of loan as of the time of death = Php 5,000.00 (GV No. ___)

Sample General Voucher

General Voucher No. 120 Representing payment of LRF under the All Loans Insurance

Package of Carmen Rosales on the balance of her loan as of

the time of her death Php 10,000.00 COMPUTATION:

Total Amt. of Loans = RL-Php 10,000.00 + HL-Php 5,000.00 = Php 15,000.00

Payment made as of the time of death = Php 10,000.00 (CV No. 115)

Balance of loan as of the time of death = Php 5,000.00 (GV No. 120)

NOTE: Voucher will be PREPARED BY who will be duly authorized by the Branch Manager, CHECKED BY the Bookkeeper and APPROVED BY the Branch Manager only.

20. Forwards accomplished vouchers to Branch Manager for signature.

BRANCH MANAGER 21. Signs vouchers. 22.Forwards the Cash or Cheque Voucher to cashier and General Voucher

to Bookkeeper.

CASHIER

23.Releases to the beneficiary the total amount indicated in the Cash

Voucher or cheque if Cheque Voucher is used.

24.Secures beneficiary’s signature who received the claim’s payment on

the appropriate space in the voucher

25.Attaches original copy of Cash or Cheque Voucher and a copy of

General Voucher to claims documents and forwards the same to MBA Coordinator.

MBA

COORDINATOR

26. Checks all the documents received and all the attachments as follows: Regardless of the loan amount availed by the deceased

member-borrower , the supporting documents should be:

 MBA Form No. 07 or 09

 MBA Form No. 13

 Death Certificate

 Birth Certificate

 Center Resolution

 Weekly Payment Schedule

 Promissory Note

 Physician’s Statement – filled up by attending

physician at the time of death.

 Certificate of Identification – accomplished by the

MBA Coordinator (Form No. 8)

 Original copy of cash or cheque voucher

 Police Report, if the cause of death is due to

accident. 27. Files all documents received.

28. Forwards all claims documents to MBA Head Office every reporting period.

END OF PROCESS

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20 Figure 3. Claims Flowchart

5.2 REQUIRED CLAIMS DOCUMENTS

1. Marriage Contract - In case of death or totally & permanently disability of member’s legal dependents.

 If the member is single (unmarried) - Marriage Contract of member’s parents in case her parent who is 60 years old and above is the who die or become totally & permanently disabled.

2. Birth Certificate – In case of death or totally & permanently disability of legitimate children.

 If the member is single (unmarried) - Member’s Birth Certificate in case her parent who is 60 years old and above is the who die or become totally & permanently disabled.

3. Death Certificate / Doctor’s Certificate of Total & Permanent Disability 4. Center Resolution

S

ECTION

6.

E

NSURING

I

NSTITUTIONAL

E

FFECTIVENESS

The capacity of Quidan Pag-inupdanay MBA in providing services to its members has been developed by CARD MBA. CARD MBA experiences in the field of Micro Insurance has been shared to Quidan Pag-inupdanay MBA . They also trained the management and staff to carry out their functions and responsibilities. The continuous support of CARD MBA and linkage with RIMANSI in terms of technical assistance shows the seriousness of Quidan pag-inupdanay MBA in running its operation professionally.

At the field level, the MBA Coordinators act as the channel for information dissemination and feedback mechanism of the Association. They attend Center Chief meetings and disseminate information in these meetings, which in turn, the Center Chiefs disseminate to members. They are also required to visit at least four (4) centers a month to know

W h e n a m e m b e r o r a n y o f h e r le g a l d e p e n d e n t d ie s o r b e c o m e s to ta lly & p e rm a n e n tly d is a b le , th e b e n e f ic ia ry s h o u ld p re p a re N o tic e o f De a th /T P D B o a rd o f A w a rd s (B OA ) w ill c o n v e n e . T h e m e m b e rs o f B OA a re th e Ce n te r Off ic e rs n a m e ly :Ce n te r S e c re ta ryCe n te r T re a s u re rCe n te r A u d ito rCe n te r A d v is e rP ro je c t Ma n a g e r a n d th e Ce n te r Ch ie f w h o w ill a c t a s th e B OA Ch a irp e rs o n . The recommendation of the BOA together with complete supporting documents will be forwarded to the MBA Coordinator for validation. W h e n a m e m b e r o r a n y o f h e r le g a l d e p e n d e n t d ie s o r b e c o m e s to ta lly & p e rm a n e n tly d is a b le , th e b e n e f ic ia ry s h o u ld p re p a re N o tic e o f De a th /T P D B o a rd o f A w a rd s (B OA ) w ill c o n v e n e . T h e m e m b e rs o f B OA a re th e Ce n te r Off ic e rs n a m e ly :Ce n te r S e c re ta ryCe n te r T re a s u re rCe n te r A u d ito rCe n te r A d v is e rP ro je c t Ma n a g e r a n d th e Ce n te r Ch ie f w h o w ill a c t a s th e B OA Ch a irp e rs o n . W h e n a m e m b e r o r a n y o f h e r le g a l d e p e n d e n t d ie s o r b e c o m e s to ta lly & p e rm a n e n tly d is a b le , th e b e n e f ic ia ry s h o u ld p re p a re N o tic e o f De a th /T P D W h e n a m e m b e r o r a n y o f h e r le g a l d e p e n d e n t d ie s o r b e c o m e s to ta lly & p e rm a n e n tly d is a b le , th e b e n e f ic ia ry s h o u ld p re p a re N o tic e o f De a th /T P D B o a rd o f A w a rd s (B OA ) w ill c o n v e n e . T h e m e m b e rs o f B OA a re th e Ce n te r Off ic e rs n a m e ly :Ce n te r S e c re ta ryCe n te r T re a s u re rCe n te r A u d ito rCe n te r A d v is e rP ro je c t Ma n a g e r a n d th e Ce n te r Ch ie f w h o w ill a c t a s th e B OA Ch a irp e rs o n . The recommendation of the BOA together with complete supporting documents will be forwarded to the MBA Coordinator for validation. T h e r e c o m m e n d a t io n o f t h e MBA Coordinator w ill b e fo r w a r d e d t o B r a n c h Ma n a g e r fo r a p p r o p r ia t e a c t io n. T h e r e c o m m e n d a t io n o f t h e MBA Coordinator w ill b e fo r w a r d e d t o B r a n c h Ma n a g e r fo r a p p r o p r ia t e a c t io n. If the recommendation of the

MBA Coordinator is for payment and concurred by the Branch Manager, indemnity payment will be disbursed immediately. If not, the claimant will

be informed of the action taken.

WE CAN PAY CLAIMS AS QUICKLY AS 3 DAYS FROM THE TIME OF DEATH WE CAN PAY CLAIMS AS QUICKLY AS 3 DAYS FROM THE TIME OF DEATH

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21 problems of the centers and solicit suggestions as how to solve the problems. The Coordinators also work closely with the Branch Managers and Technical Officers especially when it comes to claims settlement and when there are new products that are to be introduced or when there are changes that are to be made on existing products. These Coordinators receive monthly incentives and are covered for actual expenses incurred in the performance of the duties. They also perform underwriting functions that include enlisting PI and QK and non-QK PI members and monitoring status of membership. The Coordinators are the direct link of the Association to the members.

As regards to the management of risks, Quidan Pag-inupdanay MBA as a matter of procedure relies heavily on actuarial risks analysis of products introduced to members. An actuary expert is usually contracted by the Association to conduct actuarial study.

In terms of marketing and delivery of services, the Association essentially uses the existing network, the Field Offices of QK and Branches of PI. It enables the Association to effectively promote the products and transact business with its members in minimal cost.

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22

CHAPTER 3: IMPACT TO CLIENTS

On September 2008, prior to the formal organization of Quidan Pag-inupdanay MBA, RIMANSI conducted a study to measure the level of satisfaction of member-clients on the product and service delivery. The study shows very satisfactory results and even claimed that they joined in the Micro Finance Program of QK and PI because of the insurance. The program was able to meet a specific demand of client-members for insurance in case of death to cover burial expenses, to repay the loan in case of death of a member-borrower, and provident fund or retirement savings for old age. The program is very responsive to the needs of its member as it pays the claim in a maximum of three days. Meanwhile, health insurance and educational assistance are the two demands that are still unmet. The association is still conceptualizing how to address these concerns without sacrificing its sustainability.

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23

C

HAPTER

4:

FORMS

Several forms are prescribed by the associations in the entire process of its operation. This will standardize the documentation of the process involved in the

recruitment of members and payment of claims of members and their legal dependent. Below are the list of forms used and its corresponding description.

Form No. Description

QPI Form No 1 Application for Membership

QPI Form No 2 Certificate of Membership

QPI Form No 3 Notice of Additional Legal Dependents

QPI Form No 7A Notice of Death/TPD

QPI Form No 7C Notice of Hospitalization

QPI Form No 8 Certificate of Identification

QPI Form No 9 Notice Of Missing Person

QPI Form No 11 Application for Retirement / Resignation

The forms related to application of becoming a member of the association are being accompanied by Birth Certificate of member and his/her legal dependents. Married

certificate is required for all married members.

Forms used for claiming death, TPD and MVAH are accompanied by Doctor’s Certificate, Death Certificate Blotter Reports, Hospital Bill in addition to Married Contract and Birth Certificate.

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24

QPI MBA Form No. 01

Quidan Pag-inupdanay Mutual Benefit Association, Inc.

Rm. 320 VSB Bldg., 6th Lacson Sts., Bacolod City Tel. # 435 5642 email: quidanpi_mba@yahoo.com

APPLICATION FOR MEMBERSHIP

BRANCH: _____________________ CENTER_____________________ DATE FILED: ______________ DATE OF PAYMENT OF FIRST CONTRIBUTION: ____________________

APPLICANT SPOUSE (if any)

FIRST NAME MIDDLE NAME LAST NAME SEX MALE FEMALE CIVIL STATUS SINGLE MARRIED WIDOW/ER SEPARATED

DATE OF BIRTH AGE: AGE:

PLACE OF BIRTH HOME ADDRESS

OCCUPATION BUSINESS ADDRESS

(IF ANY)

LEGAL and LEGALLY ADOPTED CHILD/REN BIRTHDATE RELATIONSHIP

If married, please attach the Marriage Contract of the applicant and Birth Certificate/s of legal and legally adopted child/ren (if any). If unmarried, please attach the Birth Certificate of the applicant and Marriage Contract of legal parents (if any).

DESIGNATED BENEFICIARIES BIRTHDATE RELATIONSHIP PRIMARY

BENEFICIARY SECONDARY BENEFICIARY

I hereby state and declare that all the answers contain herein are true and correct and I fully understand that any willful misstatement in this application that would render me eligible for insurance when I would otherwise be ineligible shall be sufficient cause for the cancellation of my membership in the Association at any time such misstatement is known. In addition, the Association has no obligation on whatever claims I will file, except for the refund of my contributions, if misstatement is known during claims validation.

And I am fully aware that my legal dependents and I are covered by six (6) months contestability period.

______________________________________ SIGNATURE OF THE APPLICANT

DATE SIGNED: _________________________ PROCESSED BY: ____________________________ PROGRAM OFFICER APPROVED BY: _______________________ BRANCH MANAGER CONCURRED BY: ______________________ MBA MANAGER

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25

REGISTERED WITH INSURANCE COMMISSION LICENSE NO. : 2OO1-1-0

C er t if ic a t e Of M emb er s h ip

CERTIFICATE NO. : ________________

This is to certify that

_____________________________________________________

(MEMBER’S NAME)

of _______________________ of ________________________

(CENTER NAME) (BRANCH NAME)

is a

Member

of the Quidan Pag-Inupdanay Mutual Benefit Association, Inc. (Quidan Pag-inupdanay MBA), and is therefore entitled to all rights and privileges accruing thereto, provided his/her membership to the Quidan Pag-inupdanay MBA is continuous and provided further that he/she abides faithfully by the Rules and Regulations of the Quidan Pag-inupdanay MBA and all provisions appurtenant thereto.

This membership takes effect on ____th day of ___________________, ________.

ROLLY P. PANGANIBAN EXECUTIVE DIRECTOR APPROVED BY: DELIA M. LAGUNA PRESIDENT

Quidan Pag-Inupdanay Mutual Benefit

Association, Inc

.

Rm. 320 VSB Bldg., 7th-Lacson Street, Bacolod City, Negros Occidental Tel. (034) 435-5642 Email Address: quidanpi_mba@yahoo.com

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26

QPI MBA Form No. 03

Quidan Pag-inupdanay Mutual Benefit Association, Inc.

Rm. 320 VSB Bldg., 6th Lacson Sts., Bacolod City

Tel. # 435 5642 email: quidanpi_mba@yahoo.com

NOTICE OF AD D ITIONAL LEG AL D EPEND ENTS

FORMING PART OF CERTIFICATE OF MEMBERSHIP NO. ________________________

NAME OF INSTITUTION: ______________________________

TO : THE BRANCH MANAGER

Name of Branch: ___________________ THRU : __________________________________ NAME OF PROJECT OFFICER

FROM : __________________________________ NAME OF MEMBER

Name of Center: ___________________ DATE : __________________________________

Please be informed that the following are my additional legal dependent/s, to wit:

NAME BIRTHDATE RELATIONSHIP

Enclosed are: (whichever is applicable)

Our Marriage Contract (if got married after recognition)

Birth Certificate/s of

Legal adoption paper of ___________________________________ SIGNATURE OF MEMBER

DATE SIGNED: _________________________

Reviewed by: Approved by:

______________________________________ _______________________________ SIGNATURE OF THE BRANCH MANAGER OVER PRINTED NAME MBA MANAGER

DATE SIGNED: _________________________ DATE APPROVED: ______________________

Figure

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References

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