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Cooperative Annual Performance Report (CAPR) Form Revision No. 5
CDA report form revision no 5 for cooperative annual performance report
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: CDA-SEU-FR-003
Revision No. 5
February 7, 2017
Cooperative Development Authority
Cooperative Annual Progress Report (CAPR)
As of December 31, _______
INSTRUCTIONS TO COOPERATIVES
1. All blanks shall be filled-up with appropriate information. Do not leave any field blank. Write 0 for none and N/A for Not Applicable,
dates should be written in mm/dd/year
2. The submission of the duly accomplished Cooperative Annual Progress Report (CAPR) Form shall be done ANNUALLY within 120 days
after the end of the calendar year.
3. Submission to CDA shall be done electronically through www.cda.gov.ph in accordance with MC No. 2014-05. Likewise, the
cooperative shall submit to the Authority, through the Extension Office, one (1) copy of the encoded CAPR Form within 120 days after
the end of the calendar year.
4. The Authorized Representative of the Cooperative shall encode all the data required in the CAPR Form.
5. The Chairman and General Manager shall certify to the truthfulness and correctness of the information
contained herein.
6. All Multi-Purpose Cooperatives shall segregate records per economic activity.
GENERAL INFORMATION
A. Cooperative Identification Number (CIN):
B. Name of Cooperative as of latest amendment:
C. Present Address of Cooperative:
D. Registration Number (under RA 9520):
E. Date Registered:
Original Date of Registration :
Registration Date under RA 9520 :
F. Business Permit (as of reporting period)
Business Permit No.
Date Issued
Amount Paid
G. Category of Cooperative:
Primary
Secondary
H. Type of Cooperative: (click to select)
I. Asset Size of Cooperative:
(Pls. check only one item)
Micro (with Assets of P3,000,000 and below )
Small (with Assets of P3,000,001 to P15 million)
Medium (with Assets of P15,000,001 to P100 million)
Large (with Assets over P100 million)
Note: Land should be excluded from the Total Asset as per CDA MC 2007-07 dated June 5, 2007.
J. Common Bond of Membership: (click to select)
Institutional
K. Date of General Assembly:
L. Quorum Requirement:
Page 1 of 7
Tertiary
CDA-SEU-FR-003
Revision No. 5
February 7, 2017
M. Fiscal Year:
N. Area of Operation:
National
Regional
Municipal
Others, pls. specify
O. Business Activities:
O1. Annual Volume of Business: (select only business activities undertaken (maybe more than one) and indicate total amount
per business activity)
Business Activity
Consumer/Canteen & Catering
Labor Service/deployment of members
Lending
Marketing/Trading (non-agri products)
Production/Manufacturing
Training Providers
Sale of Agricultural Products
Provision of Services (please click below)
Practice of Profession, pls. specify
___________
Professional
Transportation
add more service activities
Bases of Volume of Business
Gross Sales
Total Contract Price
Total Amount of Gross Loan Releases
Gross Sales
Gross Sales
Gross Receipts
Gross Sales
Amount
Gross Service Revenue /Income
Gross Service Revenue /Income
Gross Service Revenue /Income
O2. Products/Commodities
Major Products
Crops
Use drop down to choose Specific Products
Banana
Corn
Check either products are raw or
processed
raw
processed
Aqua Marine
Crabs
Mussles
raw
processed
Livestocks
Pig
Ducks
Goat
raw
processed
Metal /Minerals
Lime
Gold
Iron
raw
processed
Other Products &
Commodities
Bamboo
Copra
Flowers
raw
processed
O3 Other Financial Services
Money Transfers
Remittances
Foreign Exchange Trading
ATM Operations
Bills Payment
Others, pls. specify
_______________
O4. Importation Activities, if any, identify:
Import items
Volume of Importation
P. Information on Number of Employees
Current Year
Male
Female
Number of Personnel Receiving Salaries
Number of Personnel receiving Honoraria only
Note: In case of Workers Cooperative, all workers are considered direct employees of the cooperative.
For honoraria -do not include officers receiving honoraria
Q. Contact Person (at the time of submission)
Page 2 of 7
TOTAL
CDA-SEU-FR-003
Revision No. 5
February 7, 2017
a. Name:
b. Designation:
c. Phone Number:
d. Fax Number:
e. Email Address:
R. Information on Membership
For Primary
Particulars
No. of Regular members
No. of Associate members
Total No. of Members
Male
Female
For Secondary
Primary Coops
For Tertiary
Secondary
Co-ops
Other Juridical Persons
R1. MEMBERSHIP COMPOSITION: (Please select composition and indicate number of members in each composition)
Composition
Agrarian Reform Beneficiaries
Driver / Operators / Conductors
Elderly/Senior Citizen
4Ps Beneficiaries
Livestock growers
4Ps Beneficiaries
4Ps Beneficiaries
R2. AGE GROUP OF MEMBERS
Age bracket
18 - 30
31 - 59
60 and above
No.
Composition
add more
No.
R3. List of Officers - Officers as of the Reporting Period (Indicate name and address)
R3.a. Board of Directors
NAME
ADDRESS
NAME
ADDRESS
1. CHAIRMAN 2. VICE-CHAIRMAN 3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
R3.b. Other Officers
Page 3 of 7
No.
CDA-SEU-FR-003
Revision No. 5
February 7, 2017
SECRETARY TREASURER GENERAL MANAGER R4.c. Committees of the Cooperative
NAME
ADDRESS
A. AUDIT COMMITTEE
1.
2.
3.
B. ELECTION COMMITTEE
1.
2.
3.
C. MEDIATION AND CONCILIATION COMMITTEE
1.
2.
3.
D. ETHICS COMMITTEE
1.
2.
3.
E. OTHER COMMITTEE (Please specify)
1.
2.
3.
4.
5.
S. Information on Cooperative Branches/Satellites
No. of Branches:
No. of Satellites:
S1. Details of Cooperative Branch/es
Name/Address of Branch Office
Date of Issuance
Certificate of Authority
No.
S2. Details of Cooperative Satellite
Name/Address of Satellite Office
Date of Issuance Letter of Authority No.
T. Laboratory Cooperative
No. of Members
Name and Address of Laboratory Cooperative
Student
Male
Non- Student
Page 4 of 7
Female
Student
Non- Student
Recognitio
Date Issued
n No.
CDA-SEU-FR-003
Revision No. 5
February 7, 2017
T1. Activities of Laboratory Cooperative
Activities /Services
T2. Information on Deposit Liabilities of Laboratory Cooperative
No. of Members with
deposit accounts
Type of Deposits
No. of Accounts
Total Amount
Units Owned by Members and
Managed by Cooperative
Total
Non-Members
Total
Savings deposits
Time deposits
Other types of deposits, please specify
Total
U. Information on Number of Units Owned/Managed by Transport Cooperatives
Units Owned by the
Transport Coop
Units/Vehicles
Number of Units
V. Information on Transactions to Members/Non-Members
Gross Sales / Receipts
Members
Amount of Gross Sales/Receipts
W. Certificate of Compliance (COC)
Date of Issue
COC No.
Valid Until
X. Certificate of Tax Exemption/Ruling
CTE No.
Date Issued:
Validity:
TIN
Y. Information on Deposit Liabilities
Regular Members
Type of Deposits
No. of
Members
with
deposit
accounts
No. of Accounts Total Amount
Savings deposits
Page 5 of 7
Associate Members
No. of Members
with deposit
accounts
No. of
Accounts
Total
Amount
CDA-SEU-FR-003
Revision No. 5
February 7, 2017
Time deposits
Other types of deposits, please specify
Total
Z. Information of Actual Taxes Withheld/Remitted to BIR (Total for the whole year)
Total Amount
Taxes withheld and remitted for Employees Salary/Compensation
Taxes withheld and remitted for Honorarium
Expanded Withholding Taxes
VAT Payments / Percentage Taxes
Income Taxes Paid
Other Taxes Paid, please specify
AA. Affiliations
Name of Federations/Unions
Address
AA1. Information on the Utilization of CETF - LOCAL
Name of Activity/ies
Date of Activity
No. of Members Benefitted
Amount Utilized
AA2. Information on the Remittances of CETF to Federations/Unions
Name of Federations/Union
Amount Remitted
AA3. Information on the Utilization of Community Development Fund
Name of Activity/ies
Beneficiaries
Date of Activity
Amount Utilized
Date of Project/Activity
Amount Utilized
AA4. Information on the Utilization of Optional Fund
Name of Project/Activity
Page 6 of 7
CDA-SEU-FR-003
Revision No. 5
February 7, 2017
AB. Risk Pooling Activities (activities that cover protection against death, injury and illness, loss of property, and other contingent
events.
Name of Program
Prepared By:
Partner/Insurance Provider
No. of memberbeneficiary
_________________________________________
Position
Accountant
Bookkeeper
Compliance Officer
Certified True and Correct:
General Manager
Chairman
Page 7 of 7
Amount
Crops
Aqua Marine
Livestocks
Metal /Minerals
Other Products /Commodities
Abaca
Banana
Calamansi
Cassava
Coconut
Coffee
Corn
Garlic
Ginger
Mango
Onion
Palay
Papaya
Peanut
Pineapple
Rubber
Sugarcane
Tobacco
Tomato
Crabs
Lobsters
Mussles
Oysters
Prawn
Seaweeds
Shrimps
Squid
Fish, Pls specify ______
Other Aquamarine, Pls specify ___________
Carabao
Chicken
Cow
Ducks
Goat
Pig
Sheep
Others, Pls specify __________
Bronze
Coal
Copper
Diamond
Gold
Iron
Lime
Nickel
Silver
Others, Pls specify
Bamboo
Cacao
Copra
Dairy
Farm Inputs/implements
Flowers
Gravel, stone, pebble
Handicrafts
Herbs
Mushroom
Palm oil
Rattan
RTW
Water Refilling
Rootcrops, Pls specify ________
High value vegetables, pls specify ______
Other Fruits, Pls specify ________
Others, please specify ________
Type of cooperative
1
2
3
4
Advocacy
Agrarian Reform Beneficiaries
Agriculture
Consumer
Common Bond of membership
Associational
Institutional
Occupational
Residential
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Coop Banks
Credit
Dairy
Education
Electric
Financial Service
Fishermen
Health
Housing
Insurance
Labor Service
Marketing
Multi Purpose
Producers
Professional
Service
Small Scale Mining
Transport
Water Service
Workers
Others
Services
Medical
Dental
Hospitalization
Transportation
Insurance
Housing
Electric
Water
Communication
Consultancy
Rental of Equipment/Office Space
Practice of Profession, pls. specify ___________
Others, please specify ___________
oducts /Commodities
uts/implements
s, Pls specify ________
e vegetables, pls specify ______
uits, Pls specify ________
lease specify ________
Agrarian Reform Beneficiaries
Barangay officials and employees
Driver / Operators / Conductors
Diferrently Abled Person/PWD
Elderly/Senior Citizen
Entreprenuers
4Ps Beneficiaries
Farmers
Fishermen/fisherfolks/fish vendors
Government employees and officials
Housewives/Househusbands
Livestock growers
Indigeneous People, pls. specify ____________
Informal Settlers
Military Personnel
Non-uniformed Military Personnel
Miners
Teachers/Educators
Non-teaching personnel
Overseas Filipino Workers
Private Employees
Professionals
Rebel Returnees
Religious Sector/Worker
Retired Employees/Retirees
Seaman/Seafarers
Self-employed, pls. specify nature
Skilled workers, pls. specify
Students
Vendors
Others, Pls. specify ___________________
