NMAT

National Medical Admission Test

REGISTRATION FORM
(This Form will NOT be collected on test day)

Application No.: 1052101450 DERIADA, ANGELICA ROCILLO

Reference
Bank No
Reference
No: No.:
Reference 8UEI5MV9 Name of Applicant
(Name that will appear on your Answer Sheet and Examinee Report Form)

1995-03-30 Female Philippines Single

Birthdate Sex Nationality Civil Status
LOT 7 B 26 AUSTRALIA ST. ALEXVILLE, SANTA ANA, TAYTAY, RIZAL 1920 Philippines
2 X 2 ID Picture Mailing Address (Address where your Examinee Report Form will be delivered)
N/A +63-9158961597 angelicaderiada@gmail.com
Landline No. Mobile No. Email Address

FOREIGN APPLICANT

Passport No. Expiry Date Place of Issue

Test Location: Domestic
Test Date: May 05, 2021 7AM to 11AM

REMINDERS

A. PAYMENT
A. PAYMENT
1. Bring this Registration Form to the nearest BPI or BDO branch. Pay the exact amount of ( ) on or before
1. Payment instructions have been sent to your official email address. Please pay the exact amount indicatedtransaction.
___________________ (Philippine Standard Time). The bank may charge a minimal service fee for the deposit in your payment
instructions.
2. Make sure to copy the following details in the bank’s deposit slip.
2. Only successfully paid applicants will be able to take the online NMAT. Make sure that applicable fees have been settled on
Bank
or before the date andReference Number
time indicated
in your payment : instructions. Payment made beyond the holding period will not be honored.
3. Confirm the details Name
Merchant of your transaction receipt.
:Keep
theCenter
copy of
forproof of payment
Educational for future reference.
Measurement, Inc. (CEM)
Account Number (choose one) : BPI current account number 1881-0450-24
4. A surcharge fee of Php200.00 will be collected to process refund request due to over or double payment and processing of
any
special request or correction (i.e. change of mailing address etc.) OR
BDO savings account number 0048-8008-5327
B. REQUIRED DOCUMENTS
1. Email a pdf file
3. Confirm the of Transcript
details of yourof Records receipt
transaction (for graduate applicants)
(double-check or Certificate
the bank to Graduate
reference number (for graduating
and account applicants)
number). Keep the copytoof
nmatdocs2020@gmail.com OR nmatdocs2020@yahoo.com.
deposit or transaction slip for future reference.
2. For updates, visit the website at www.cem-inc.org.ph/nmat
4. Avoid making payment transactions via ATM, online, or mobile fund transfers. These are NOT traceable to your NMAT
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application. You will need to pay the full amount again.

5. A surcharge fee of Php 200.00 will be collected to process refund request due to over or double payment and processing of any special
request or correction.
Downloaded on: Mar 08, 2021 01:25pm

B. REQUIRED DOCUMENTS
1. Email a pdf file of your Transcript of Records (for graduate applicants) or Certificate to Graduate (for graduating applicants) to
nmatmarch2020@gmail.com using this subject header format: Application Number_Last Name First Name. These
documents will NOT be collected on test day. Failure to do so will disqualify you from taking the NMAT.

C. EXAMINATION PERMIT
1. Visit the official website at least a week before the test date to know your room assignment and to download your Examination Permit.
YOU ARE REQUIRED TO BRING THE EXAMINATION PERMIT TOGETHER WITH A VALID ID ON TEST DAY.

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