BJMP Mutual Benefit Association Inc. CLIENT PORTAL

Apply as a New Member

Personal Info

Membership Type *

Regular Member Associate Member

Effectivity date

Account Number

Last Name *

First Name *

Middle Name

Gender *

Birthdate *

Birthplace

Note: Please avoid selecting the City of Manila as your City/Municipality option. Instead, kindly choose a relevant sub-municipality.

Province

City/Municipality

Home Address

Note: Please avoid selecting the City of Manila as your City/Municipality option. Instead, kindly choose a relevant sub-municipality.

Region *

Province *

City/Municipality *

Barangay *

Street *

Unit Address

Office Address

Note: Please avoid selecting the City of Manila as your City/Municipality option. Instead, kindly choose a relevant sub-municipality.

Region

Province

City/Municipality

Barangay

Street

Unit Address

Civil Status

Single

Married

Separated

Widow/widower

Contact Information

Contact Number *

Example: (09xxxxxxxxx)

E-mail Address *

Rank/Title

Valid ID

ID Type *

ID Number *

Other Valid IDs (optional)

TIN ID

ID Number

SSS/UMID ID

ID Number

PhilHealth ID

ID Number

Pag-ibig ID

ID Number

Health Declaration

NOTE: Please provide details through document attachments about furnish dates, diagnoses, results of examination, names & address of physicians or hospitals.

Have you been treated for or been advised that you have any of the following: Heart, Lung, Nervous or Kidney Disorder, Cancer, High Blood Pressure, Tumor, Diabetes?
Yes
No
Do you or did you have any illnesses not mentioned in (a) above?
Yes
No
During the last five years have you been hospitalized or have you been confined or treated by a physician for any reason?
Yes
No
Are you now in good health and free from physical impairment, any deformity or disease?
Yes
No

Beneficiaries

Last Name *

First Name *

Middle Name

Relationship *

Add Beneficiary

Monthly Contribution

NOTE: Regular members are required a monthly contribution of 3% of their salaries while for associate members, monthly contribution should be between Php 500 to Php 895.

Monthly contribution *

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