Certification Examination Application

APPLICATION DATE 7/15/2022

PRINT DATE 7/15/2022

PROGRAM: CERT-I 671570

CATEGORY: IMLS
ROUTE: 1
ORDER NO: 4006780777
CUSTOMER FILE COPY
CUSTOMER ID: 25841480 KEEP FOR YOUR RECORDS
RETAKE: N

PERSONAL INFORMATION PAYMENT INFORMATION

FIRST NAME: SETH WENEFRED Date/Amount Paid: 7/15/2022 $200.00

LAST NAME: CATUHAO Payment Method: Credit card ending in 7878
MIDDLE NAME: ESPINOSA Invoice #: 0099608605
MAIDEN
NAME: M
GENDER:

CONTACT INFORMATION

PHONE: 6309198304947
EMAIL: sethcatuhao19@gmail.com
ADDRESS: PUROK PAGLAUM
LINAO MATALAM NORTH COTABATO DATE OF BIRTH 11/14/1998
MATALAM, 9406 Philippines

OTHER CERTIFICATION

None

EDUCATION

PROG TYPE: Academic CITY: Kidapawan City

INSTITUTION NAME: Kidapawan Doctors College STATE:
Incorporated
DEGREE: BS COUNTRY: PHL
SCHOOL CODE: BEGIN DATE: 06/22/2015
END DATE: 04/16/2019
PROGRAM DIRECTOR: KARRIZA MAE M. GUBOC
PHONE: 09956690079 EMAIL: karizzamaemanagbanag@gmail.
com
INTIL LICENSE NO: 0098353 INTIL PROGRAM: Bachelor in Medical Laboratory
Science

TRAINING

INSTITUTION: St. Elizabeth Hospital DATE STARTED: 10/1/2018

Incorporated

1
 Certification Examination Application

ADDRESS: Santiago Blvd, National Highway END DATE: 4/14/2019

Genaral Santos City, 9500
PROGRAM DIRECTOR: KARRIZA MAE M. GUBOC,RMT PHONE: 09956690079
E-MAIL: karizzamaemanagbanag@gmail. EXT:
com