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Survey Form Sample


welcome By: Elena Grace Flores
GENERAL SURVEY FORM FOR GENERATION OF FUNDS

I: CELL SITE
Our village has been identified as a suitable cell site venue – but we cannot qualify on this yet because of lack of requirements. Ericsson’s cell site contractor is also still in the process of securing necessary government permits like the DOH certification required by law. Therefore, this is a long process to realize if not impossible. Just for the record, we would like to know of your opinion: Are you in favor of this cell site project with a monthly rent estimated at 40,000 Pesos – to help fund our special projects and maintain operational costs?
Yes: _____    No: _____ Why? ___________________________________________________

II: GUARD HOUSE
The recommended design of the developer/investor will give more space and control at the entrance despite the manual boom. The contractor’s estimated quote so far is 169,000.The investor already paid the down payment to the contractor – but we have to pay half of the final cost ASAP and commit how to settle the remaining 50% before end of December 2014.  (Please check what applies to you):
____ Yes, I have paid the mandatory contribution of _____Php 500 for residential homeowners or ____ 1,000 for commercial operators. I would like to donate more, the amount of _____________________.
____ No, I have not paid but I will pay the mandatory contribution of _____Php 500 for residential homeowners or ____ 1,000 for commercial operators on ____________________. I want to donate more the amount of ________________________________.
____ Yes, I am willing to increase my monthly dues from __________ Pesos to __________ Pesos (minimum of Php 200 increase)
____ No, I do not want to pay more for my monthly dues.

III: CASIMIRO VILLAGE PHASE 3 MULTIPURPOSE COOPERATIVE
The cooperative group was setup based on the investor’s contract requirement to safeguard the return of investment for the pay parking facilities initially with 20 Cooperators. Note that the main purpose of the Cooperative is to run businesses in a form of service facilities that can make CV3 sustainable – so profit sharing can only be decided upon when there’s no more shortage of funds for the village:
____ Yes, I would like to be a member of the Cooperative investing minimum of 10,000 Pesos and maximum of 60,000. (Investment increase is not compulsory). I will pay the first 2,500 Pesos (25%) on ______________________ and the rest (7,500 Pesos) on ___________________________________.
____ No, I’m not interested in the Cooperative.
Name over signature of Homeowner                Name/Signature of Proxy

PLEASE NOTE THAT THIS SURVEY FORM MUST BE CASTED IN PERSON ON JULY 25, 2014 (FRIDAY) AT 8:00 PM, ALVAREZ RESIDENCE DURING THE GENERAL MEETING! DOUBLED COMPULSORY DONATION WILL BE IMPOSED FOR ABSENTEE VOTERS – For STRICT COMPLIANCE as ordered by: ___________________________________Flaviano Alvare

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