Acknowledgement Receipt: I Hereby Declare That All Information Given Are True and Correct To The Best of My Knowledge

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PERSONAL INFORMATION:

FIRST NAME: __________________________MIDDLE INITIAL: _____ LAST NAME: ______________________

GENDER: ________ BIRTHDATE: ____________________ CONTACT NO.:______________________________

EMAIL ADDRESS: ________________________________ FIDE RATING: _____________ TITLE: _____________

SSS/GSIS NO: ___________________________________ TIN: _______________________________________

ADDRESS: _________________________________________________________________________________

CONTACT PERSON INFORMATION:

FIRST NAME: ___________________________MIDDLE INITIAL: _____ LAST NAME: ______________________

CONTACT NO: __________________________EMAIL ADDRESS: ______________________________________

ADDRESS: _________________________________________________________________________________

I HEREBY DECLARE THAT ALL INFORMATION GIVEN ARE


TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

Date of membership:
______________________________
Amount:
______________________________
Received By:
______________________________

SIGNATURE
NOTE: PLEASE SIGN AT THE CENTER OF THE BOX

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ACKNOWLEDGEMENT RECEIPT
This is to certify that _________________________________________ has paid ______________ pesos only
for NCFP Membership (valid for one year).

___________________________________
(NCFP) AUTHORIZED SIGNATURE

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