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ASATA Form

Shirley D. Sangalang applies for membership with the Batangas Public School Teachers, Employees and Retirees Association Inc. (BPSTERA). She is a 53 year old married female and the Head Teacher III at Pamiga Elementary School in Agoncillo, Batangas. Her sole beneficiary is listed as her son, Jherwin D. Sangalang. She certifies that the information provided is true and correct, and that she will abide by the rules and regulations of the association.

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120 views2 pages

ASATA Form

Shirley D. Sangalang applies for membership with the Batangas Public School Teachers, Employees and Retirees Association Inc. (BPSTERA). She is a 53 year old married female and the Head Teacher III at Pamiga Elementary School in Agoncillo, Batangas. Her sole beneficiary is listed as her son, Jherwin D. Sangalang. She certifies that the information provided is true and correct, and that she will abide by the rules and regulations of the association.

Uploaded by

DEMETRIA ESTRADA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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BATANGAS PUBLIC SCHOOL TEACHERS, EMPLOYEES AND

RETIREES ASSOCIATION INC. (BPSTERA)


Provincial Sports Complex Bolbok, Batangas City
Tel. No. 702-4174

APPLICATION FOR MEMBERSHIP

1. Name of Applicant: SANGALANG SHIRLEY DINGLASAN


_____________________________________________________________________
(Surname) (First Name) (Middle Name)
2. Age: _____53_______ 3. Sex: __ Female
____ 4. Civil Status: ___M __
5. Name of Spouse: ______HILARIO D.
SANGALANG________________________________________
6. Permanent Address: __Coral na Munti _____________Agoncillo______________ Batangas
______
(Street/Barangay) (Municipality) (City/Province)
7. DepEd Employee at present:___Pamiga Elementary
School_______________________________
a. Position: _____Head eacher
III_______________________________________________________
b. Entity:
_________Agoncillo_________________________________________________________
__
(District) (Secondary) (Division Office)
8. Name of School Division: __Division of Batangas
Province_______________________________
(Bats. Prov.) (Bats. City) (Lipa City) (Tanauan City)

9. Are you on sick leave of absence? ______No___ If so, why?


_________________________________
10. Beneficiaries: (If married, the spouse and the children are automatically the beneficiaries unless
otherwise signed in writing under oath)

NAME RELATION SHARES


Jherwin D. Sangalang Son

Note: if this space is not enough please use the reverse side to list the other beneficiaries:

Herewith attached are the following:


1. P/ 20.00- Membership- BPSTERA
2. P/ 20.00- Annual Due
3. P/ 20.00- Membership Fee- ASATA
4. P/ 45.00- Advance Abuloy good for 9 deaths
BATANGAS PUBLIC SCHOOL TEACHERS, EMPLOYEES AND
RETIREES ASSOCIATION INC. (BPSTERA)
Provincial Sports Complex Bolbok, Batangas City
Tel. No. 702-4174

I hereby certify that the above information’s are true and correct. I further certify that
I have read the RULES and REGULATIONS governing the ASATA and shall abide fully by
the terms and conditions.

Date: ___October 07, 2021_____ _SHIRLEY D.


SANGALANG___
Signature of Applicant

APPROVED:
CONIE C. HERNANDEZ
BPSTERA-ASATA PRESIDENT/ MANAGER

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