I Am The One Essay

571 words - 3 pages

NMAT

National Medical Admission Test

Application No.:
Bank Reference No.:

1101505356
2599672320

IDENTIFICATION (ID) FORM
(Must be SUBMITTED to the Examiner on the day of the test)

AHRJAY DE GUZMAN ATIENZA
Name of Applicant (name that will appear on your Answer Sheets and Examinee Report Form)

1992-08-11
Birthdate

Male

Philippines

Single

Sex

Nationality

Civil Status

Centro Escolar University - Manila, Manila City, Metro Manila (NCR)
Name of College Graduated From

2 X 2 ID Picture

Metro Manila (NCR)

Philippines

State/Province of College Graduated From

Country of College Graduated From

BS in Medical Technology

2013-2014

College Course (Bachelors Degree)

School Year Graduated

contact information
UKAY-UKAY BARGAIN CENTER OLD PUBLIC MARKET SANFERMIN, Cauayan, Isabela 3305 Philippines
Test ...view middle of the document...

Medical Foundation

Passport No

Expiry Date

Place of Issue

3. Our Lady of Fatima University - College of Medicine

FOR THE NMAT APPLICANT
PHP1900.00
1.  Bring this Form to the nearest Bank of the Philippine Islands (BPI) branch and pay the total of NMAT Registration and Test Fees (PhP________) on or before
October 02, 2015
___________________.
Copy the Bank Reference No. found on the upper left portion of this Form and CEM’s BPI account number 1881-0450-24 on the BPI Payment/
Deposit Slip. BPI may collect PhP30.00 - PhP50.00 as additional service charge.

2.  Check your email (including your spam mailbox) after two (2) business days for your payment confirmation email. You may also visit the NMAT website to verify
the status of your NMAT application and to download the NMAT Practice Set after payment has been confirmed.
3.  Visit the NMAT website two weeks before the test date to know your room assignment and to download your Examination Permit.
4.  Affix your signature on the certification below:
I hereby certify that I have read, fully understood, and accepted all the information, terms and conditions specified on the NMAT Bulletin of Information and on
the NMAT website www.cem-inc.org.ph/nmat, including, among others, the NMAT policies on refund of test fees, on cheating or improper test-taking behavior in
any manner or form, and on failure to take or complete the test on the test date and test center indicated on this Form. I further certify that all information I gave
on this Form is true and correct to the best of my knowledge and that any misinformation shall constitute grounds for my disqualification from taking the NMAT
or invalidation of my NMAT results.
Applicant’s Signature

Date Signed

Bring and submit also to your Examiner on the day of the test a photocopy of your official
Transcript of Records (TOR) issued by the College where you graduated from. Your NMAT
results shall be witheld indefinitely if you fail to submit a photocopy of your TOR and/
or this NMAT ID Form.

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