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Philippine Law School Admission Test (Must be SUBMITTED to the Watcher on the day of the test)

Application No.: 2041706355

Bank Reference No.: 3799122811 AMIEL LYNDON BABIANO PELIAS
Name of Applicant (Name that will appear on your Answer Sheet and Certificate of Eligibility)
1995-06-18 Male Philippines Single
Birthdate Sex Nationality Civil Status
University of the Philippines In the Visayas Tacloban College, Tacloban City, Leyte
Name of College Graduating From
2 X 2 ID Picture Leyte Philippines
State/Province of College Graduating From Country of College Graduating From
AB in Political Science 2016-2017
College Course (Bachelors Degree) School Year Graduating

contact information

Test Location: Tacloban City

SITIO ILAWOD ST. MICHAEL, Palo, Leyte 6501 Philippines
Home Address
Test Date: April 16, 2017
SITIO ILAWOD ST.MICHAEL, Palo, Leyte 6501 Philippines
Results to be: Sent via postal mail
Mailing Address
Contact information released to requesting
law schools? Yes N/A +63-9168564179
Law School Choices: Landline Mobile Email

1st: University of the Philippines - Diliman Foreign applicant

2nd: Dr. V. Orestes Romualdez Educational Foundation
3rd: University of San Carlos Passport No. Expiry Date Place of Issue


1. 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 PhiLSAT website www.cem-inc., including, among others, the PhiLSAT policies on allowed and prohibited items, on cheating or improper test-taking behaviour in any manner
or form, and on failure to take or complete the test on the test date and testing location 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 PhiLSAT or
invalidation of my PhiLSAT results.

Applicants Signature Date Signed

2. Bring this Form to the nearest Bank of the Philippine Islands (BPI) branch and pay the PhiLSAT Testing Fee (PhP________)
PHP1000.00 on or before
April 03, 2017

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.
3. Check your e-mail (including your spam mailbox) after two (2) business days for your payment confirmation e-mail. You must also visit the PhiLSAT website
to verify the status of your PhiLSAT application.
4. Visit the PhiLSAT website two weeks before the test date to know your room assignment and to download your Examination Pass.
5. Secure from the office of your College/University Registrar an official Certification that you are a candidate for graduation from the college/university
with the college degree course and on the school year indicated on this Form. You must have this Certification duly notarized by a notary public.

On the day of the test, you must bring and submit to your Watcher, the Notarized Certification from your
College/University Registrar and this PhiLSAT ID Form. Your PhiLSAT results shall be withheld indefinitely if
you fail to submit any of these two requirements.