This document is an identification form for the National Medical Admission Test (NMAT) applicant. It provides instructions for the applicant to bring the form to their school for signature verification, pay registration and test fees at the Bank of the Philippine Islands, and check their email for a payment confirmation. It also notes that applicants should visit the NMAT website two weeks before the test to get their room assignment and examination permit. The bottom of the form requires signatures from the applicant and school head to certify the applicant's student status and identity.

1. NMATNational Medical Admission Test
IDENTIFICATION (ID) FORM
FOR THE NMAT APPLICANT
1. Bring this Form to your school. Your School Head must affix his/her signature on the space provided below to certify that you can graduate by the end of the
school year stated above.
2. Bring this Form to the nearest Bank of the Philippine Islands (BPI) branch and pay the total of NMAT Registration and Test Fees (PhP________) on or before
___________________ (Philippine Standard Time).
Copy the Bank Reference No. found on the upper left portion of this Form and CEM’s BPI account number 1881-0450-24 on the BPI Payment/
Deposit Slip. BPI may collect PhP30.00 - PhP50.00 as additional service charge.
3. 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.
4. Visit the NMAT website two weeks before the test date to know your room assignment and to download your Examination Permit.
5. 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.
Applicant’s Signature Date Signed
FOR THE SCHOOL HEAD
Please affix your signature on the space provided below to confirm the identity and academic status of the NMAT applicant.
I hereby certify that the person in the picture above can graduate from ________________________________________________________________
with a college (bachelors) degree of/in ____________________________________________________________ by the end of school year ______________.
He/She can apply for admission to any Philippine medical college in the next schoolyear ________________.
Signature & Printed Name of School Head Designation Date Signed
(Must be SUBMITTED to the Examiner on the day of the test)
Name of Applicant (name that will appear on your Answer Sheets and Examinee Report Form)
Birthdate Sex Nationality Civil Status
Name of College Graduating From
State/Province of College Graduating From Country of College Graduating From
College Course (Bachelors Degree) School Year Graduating
contact information
Home Address
Mailing Address
Landline Mobile E-mail
(For Foreign Applicant only)
Passport No Expiry Date Place of Issue
Application No.:
Bank Reference No.:
Test Center:
Test Date:
Results to be:
Test results and NMAT ID information released
to requesting medical schools?
Medical School Choices:
1.
2.
3.
2 X 2 ID Picture
1101504481
3725117734
Baguio City
October 25, 2015
Sent via postal mail
Yes
University of Northern Philippines-College of Medicine
Angeles University Foundation-College of Medicine
Manila Central University - Filemon Tanchoco Sr. Medical Foundation
PRINCE ANTONY DURAI ROBERT HENTRY DURAI
1997-01-02 Male India Single
University of Northern Philippines - Main, Vigan City, Ilocos Sur
Ilocos Sur Philippines
BS in Biology 2015-2016
NEW INTERNATIONAL STUDENT DORMITORY,ZONE 1 ANCHETA ROAD ,NEAR ILOCOS SUR COOPERATIVE MEDICAL MISSION
HOSPITAL ,TAMAG VIGAN CITY,ILOCOS SUR,2700 PHILIPPINES, Vigan City, Ilocos Sur 2700 Philippines
DR.BENJIE N.GAPATE,HEAD-INTERNATIONAL STUDENT SERVICES,UNIVERSITY OF NORTHERN PHILIPPINES TAMAG VIGAN
CITY,ILOCOS SUR ,2700 PHILIPPINES, Vigan City, Ilocos Sur 2700 Philippines
+63-9232035888 +63-9232035888 prinzzantony@gmail.com
M5864801 January 27, 2025 MADURAI
PHP1900.00
October 02, 2015
University of Northern Philippines - Main, Vigan City, Ilocos Sur
BS in Biology 2015-2016
2016-2017
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