AGREEMENT I, whose name and signature appear herewith, do hereby voluntarily apply for the privilege of being a member and agent of NGBMPC as an independent Member/Agent. I understand that my membership does not make me, in any manner whatsoever, an employee or a representative of NGBMPC or my sponsor. That, as an independent NGBMPC Member/Agent, I am personally responsible for the satisfaction of local and national laws and regulations with regards to taxes, permits, licensures, etc. That, my Agent/Sponsor is permanent and cannot be changed for whatever reason(s) once this application has been accepted. That, only thru my strict compliance with NGBMPC, its policies and guidelines, rules and regulations, and any future modifications and amendments thereof, shall entitle me for earnings and rebates. That in the event that I did not renew my Insurance coverage, I will lose my downlines and privileges of earning in the marketing plan. That, NGBMPC reserves the right to suspend, and even terminate my membership at any time due to my negligence, false claims, misrepresentation, unethical business conduct, and direct or indirect violation of the existing policies and guidelines of the Cooperative which is tantamount to a breach of this agreement. That, NGBMPC reserves the right to revoke, suspend, modify, or alter any or all of the terms and conditions of this agreement, the marketing plan, pricing and/or its supplements at any time during its effectivity for any reason NGBMPC may find just, reasonable and fair for the advantage of its members and the purpose of protecting the welfare of the Cooperative as a whole. That, the Insurance Coverage or Memorial Service Assistance shall only be enforced once an Approval Letter and Official Receipt has been issued. I understand that the Leadership Incentive is a privilege given to Member-Leaders in good standing. In case of Auto-deduct, NGBMPC shall not be held liable for any civil and criminal charges for any lapsation of my Insurance that may occur. I agree to be an associate member (limited) of NGBMPC and that the Insurance or Memorial Service Assistance are benefits I shall get provided I pay my coverage annually for the Insurance. I certify that I have read and understood the Agreement & Procedures and Important Reminders, and that I agree to be bound by them. I hereby certify that the written information are true and correct to the best of my knowledge. I am making a contract with NGBMPC to provide the Memorial Services in time of need. I am assigning the insurance claims to NGBMPC as payment for the services rendered. In case the Insurance Company denies the claim for any legal reasons, my family shall pay for the services rendered. Signature: ______________________________________________ Date: __________________________________________________ 140808 NOTE: THIS APPLICATION FORM SHOULD BE DULY SIGNED BY THE MEMBER. Memorial Service is provided by: See List of Servicing Mortuaries nationwide. Call NGBA Head Office: (02) 250-1026 Our Insurance Providers: BENEFICIAL LIFE INSURANCE CO., INC. COOPERATIVE INSURANCE SYSTEM OF THE PHILIPPINES Service Administrator: New GlobalBiz Assist Inc. (NGBA) NGB Multipurpose Cooperative (NGBMPC) Units 67 & 69 Hillside Plaza Bldg. Sumulong Highway, Antipolo City (02) 250-1026 / 250-2057 PAYMENT COLLECTING AGENT: NGBA INC. Deposit payments to: NEW GLOBALBIZ ASSIST INC. BDO C/A No. 002468009067 SM HYPERMARKET CAINTA BRANCH SPONSOR: IMPORTANT: ID. NO.: Notify NGBA Head Office once deposit is made for processing of Insurance/HMO. E-mail name, membership, and deposit slip to [email protected]. BC: 140808 NGB MULTIPURPOSE COOPERATIVE Unit 67 Hillside Plaza Bldg. Sumulong Highway, Antipolo City FAST TRACK SOLUTION to the HIGH COST of LIVING the FT-999 For only P999.00 a year, you have the protection of: P20,000 Life Insurance with the option to avail the Memorial Service Assistance (MSA) currently worth P40,000.00 - 5-day residential viewing P5,000.00 Cash P10,000.00 Accidental Death & Dismemberment FT-1299 For only P1299.00 a year, you have the protection of: P35,000 Life Insurance with the option to avail the Memorial Service Assistance (MSA) currently worth P70,000.00 - 3-day chapel viewing P5,000.00 Cash P10,000.00 Accidental Death & Dismemberment *If MSA is to be availed, the claim proceeds from the Life Insurance shall be used to pay the service value to the servicing mortuary. MEMORIAL SERVICE ASSISTANCE includes: 1. Pick-up of remains from residence or hospital 2. Embalming for 3 to 5 days viewing*(includes dressing and make-up of the remains) 3. Casket* assigned in your MSA 4. Use of a chapel* if included in your MSA 5. Expanded assistance to include free use of lighting equipment, funeral hearse for the interment 6. Assistance in documentation *Depending on your MSA and Servicing Mortuary WHO CAN APPLY? All Filipino citizens age 18-64 years old are eligible to enroll. Note: One-year contestability period applies. Servicing Mortuary: OPEN Remarks:_______________________________ A P P L I C AT I O N As a MEMBER – AGENT, earn on the Marketing Plan! MARKETING PLAN Direct Referral (FT-999) Direct Referral (FT-1299) 2nd to 8th Level - P100.00 - P150.00 - P40.00 New Renewal M-999 M-1299 U-499 A one-time payment of P50.00 Activation Fee is required upon enrollment. PLEASE PRINT LEGIBLY ID NO.: PERSONAL INFO LAST NAME: FIRST NAME: Example: You sponsored 5 Members/Agents Level 1st 1st 2nd 3rd 4th 5th 6th 7th 8th YOUR PROJECTED INCOME 5 5 25 125 625 3,125 15,625 78,125 390,625 x x x x x x x x x P100.00 (FT999) = P150.00 (FT1299)= P40.00 = P40.00 = P40.00 = P40.00 = P40.00 = P40.00 = P40.00 = P500.00 P750.00 P1,000.00 P5,000.00 P25,000.00 P125,000.00 P625,000.00 P3,125,000.00 P15,625,000.00 FORM AGE: MIDDLE NAME: GENDER: BIRTHDATE: HEIGHT: CIVIL STATUS: BIRTHPLACE: WEIGHT: RELIGION: ADDRESS: TEL. NOS./ CEL. NOS.: E-MAIL ADDRESS: NOTE: One Recruit Policy applies. This requires every agent to recruit at least one (1) new agent or client every month to benefit from the unilevel marketing system. OCCUPATION: TIN: BENEFICIARY PLUS! Earn 24 to 34% outright and monthly income on your Member/Client. NOTE: Earn 15 to 23% outright and monthly income on your Member/Client Renewal. start earning now LAST NAME AGE: GENDER: FIRST NAME BIRTHDATE: MIDDLE NAME RELATIONSHIP: Are you to the best of your knowledge in good health and free from any deformity? ( ) YES ( ) NO If NO, please give details ___________________________________________________ MORE AT THE BACK