BOCAUE TEACHERS AND EMPLOYEES ASSOCIATION-PUBLIC ELEMENTARY
SCHOOLS (BTEA-PES)
Wakas, Bocaue Bulacan
APPLICATION FOR MEMBERSHIP TO THE BTEA-PES RETIREMENT AND
MUTUAL AID SYSTEM
VINCENT C. VILLAMORA MALE
1. NAME____________________________________________SEX________CIVILSTATUS______________ SINGLE
2. DATE OF BIRTH________________
JULY 31, 1986 PLACE OF BIRTH____________________________AGE________
STA.MARIA, BULACAN 34
3. HOME ADDRESS ______________________________________________________________________
1453 GOV. F. HALILI AVE., TURO, BOCAUE, BULACAN
4. STATION______________________________________________
BUNDUCAN ELEMENTARY SCHOOL BOCAUE DESIGNATION_________________
MASTER TEACHER I
(School) (District)
5. NAME OF PARENTS (Father)__________________________(Mother)_____________________________
ANTHONY I. VILLAMORA NORMA A. CRUZ
(DECEASED)
6. NAME OF SPOUSE _________________________________
N/A OCCUPATION________________________
N/A
7. BENEFICIARIES:
NAME ADDRESS DATE OF RELATIONSHIP
BIRTH
_____________________________
NORMA A. CRUZ ___________________________
TURO, BOCAUE, BULACAN OCTOBER
____________
11, 1949________________
MOTHER
_____________________________ ___________________________ ____________ ________________
_____________________________ ___________________________ ____________ ________________
_____________________________ ___________________________ ____________ ________________
(NOTE: If this space is not enough, please use another sheet for other beneficiaries)
(ANY REQUEST FOR CHANGES OF BENEFICIARIES LISTED HEREIN SHOULD BE UNDER OATH)
8. DEATH ASSISTANCE
NAME AGE RELATIONSHIP
_____________________________________
NORMA A. CRUZ ___________
71 ________________________________
MOTHER
_____________________________________
MA. LOURDES CARMELA C. VILLAMORA ___________
43 ________________________________
SISTER
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
_____________________________________ ___________ ________________________________
(NOTE: If this space is not enough, please use another sheet for other member of the family seeking assistance)
(I hereby declare that the following is/are my family member within second degree of consanguinity and first
degree of affinity)
9. FIRST DAY OF SERVICE IN PUBLIC SCHOOL: ___________________________________
JULY 19, 2009
10. DATE OF MEMBERSHIP TO THE BTEA-PES _________________________________
JUNE 4, 2021
I hereby understand the constitution and bylaws of the association and my membership is voluntary and
will adhere with its rules and regulations. Write “YES”if you understandYES
_____________________________
I hereby certify that the above information is true and correct. I further certify that I have read the Rules
and Regulations pertaining to the benefits as written in the Constitution and Bylaws of the association, and I
abide fully by the term of the same without any reservation.
______________________
Customary Signature
___________________
JUNE 4, 2021
DATE 4274651
EMPLOYEE NO. __________________
POSITION: _______________________
MASTER TEACHER I
Passport Size Picture
(4.5cm. x 3.5cm.)
I hereby certify that the applicant is actually in the service.
RECOMMENDING APPROVAL:
______________________
ROSARY V. SINDAYEN CERTIFICATE OF MEMBERSHIP NO. ________
Immediate Superior/Principal I DATE OF EFFECTIVITY____________________
APPROVED: ______________________________
____________________________________
OLIVER M. MANGAO
BTEA-PES President/MT-II
Important: Please accomplish this form in Triplicate (3) and submit same to the BTEA-PES office with P100.00 membership fee (if new
member), a receiving copy will be given to the member and school where the member belongs.
