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Mailing Address
Email Address Date of Birth (MONTH/DD/YYYY | June/11/2007) Age Sex Contact Number
Female Male
LRN (if available) Date of Registration (MONTH/DD/YYYY | June/11/2007) Last Grade Level Completed Level you are registering for
* For applicants from the private schools only Name & Signature of Evaluator / Date
** From the Regional/Division Office; for applicants from schools without Gov't permit
Disclosure: By accomplishing this Registration Form, the registrant hereby consents to collecting, processing, and storing of personal data by the Bureau of Education Assessment
for the exclusive purpose of facilitating his/her application for the Philippine Educational Placement Test (PEPT).
Proof of Payment
OR No. : Name & Signature of Evaluator / Date
Republic of the Philippines
Department of Education
BUREAU OF EDUCATION ASSESSMENT
0 0
Name of School Last Attended
0
Address of School Last Attended
0
Examination Center Division Code
DEPED CENTRAL OFFICE - BEA BEA-EAD
OR No.
On examination day, the test will start at 7:30 a.m. Bring a printed copy of this examination permit, scanned copy of Official
INSTRUCTION TO THE EXAMINEE Receipt, original copies of documents submitted online, a valid ID and 2 lead pencils.
EVALUATION REMARKS:
Name of Evaluator
Date/Time: