NMAT

National Medical Admission Test

Application No.:
Bank Reference No.:

1041600777
2821238275

IDENTIFICATION (ID) FORM

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

PAUL ANTHONY DONASCO LONTOK

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

1994-12-10
Birthdate

Male

Philippines

Single

Sex

Nationality

Civil Status

Batangas State University - Main, Batangas City, Batangas

Name of College Graduated From

2 X 2 ID Picture

Batangas

Philippines

State/Province of College Graduated From

Country of College Graduated From

BS in Biology

2014-2015

College Course (Bachelors Degree)

School Year Graduated

contact information
ABACAN SUBDIVISION BARANGAY CALICANTO, BATANGAS CITY, Batangas City, Batangas 4200 Philippines
Test Center: Manila
Test Date:

April 17, 2016

Results to be: Sent via postal mail

Home Address
ABACAN SUBDIVISION BARANGAY CALICANTO, BATANGAS CITY ABACAN SUBDIVISION BARANGAY CALICANTO, BATANGAS CITY,
Batangas City, Batangas 4200 Philippines

Mailing Address

+63-9805289

Test results and NMAT ID information released

to requesting medical schools? No

Landline

Medical School Choices:

(For Foreign Applicant only)

1. University of Northern Philippines - College of Medicine

2. Pamantasan ng Lunsod ng Maynila - College of Medicine

Passport No

+63-9356849321

paulanthony.lontok@yahoo.com

Mobile

E-mail

Expiry Date

Place of Issue

3. Our Lady of Fatima University - College of Medicine

FOR THE NMAT APPLICANT

PHP1900.00 on or before
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________)
April 01, 2016
___________________.
Copy the Bank Reference No. found on the upper left portion of this Form and CEMs 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.
Applicants 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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