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    Identification (Id) Form: Contact Information

    Uploaded by

    Subhash Bera
    1. This document is an identification form for Himanshu Kumar Singh to take the National Medical Admission Test (NMAT) on March 26, 2017. It contains his personal details like name, date of birth, nationality, contact information, and college information. 2. It specifies the test center as Manila and that test results will be sent via postal mail. It also lists his top three medical school choices. 3. The form requires signatures from the applicant and his school head to certify his student status and ability to graduate from his undergraduate program by 2016-2017. It outlines policies on payment, test day procedures, and consequences of misinformation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Identification (Id) Form: Contact Information

    Uploaded by

    Subhash Bera
    109 views1 page
    1. This document is an identification form for Himanshu Kumar Singh to take the National Medical Admission Test (NMAT) on March 26, 2017. It contains his personal details like name, date of birth, nationality, contact information, and college information. 2. It specifies the test center as Manila and that test results will be sent via postal mail. It also lists his top three medical school choices. 3. The form requires signatures from the applicant and his school head to certify his student status and ability to graduate from his undergraduate program by 2016-2017. It outlines policies on payment, test day procedures, and consequences of misinformation.

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    Original Title

    1031705575

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    1. This document is an identification form for Himanshu Kumar Singh to take the National Medical Admission Test (NMAT) on March 26, 2017. It contains his personal details like name, date of birth, nationality, contact information, and college information. 2. It specifies the test center as Manila and that test results will be sent via postal mail. It also lists his top three medical school choices. 3. The form requires signatures from the applicant and his school head to certify his student status and ability to graduate from his undergraduate program by 2016-2017. It outlines policies on payment, test day procedures, and consequences of misinformation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    109 views1 page

    Identification (Id) Form: Contact Information

    Uploaded by

    Subhash Bera
    1. This document is an identification form for Himanshu Kumar Singh to take the National Medical Admission Test (NMAT) on March 26, 2017. It contains his personal details like name, date of birth, nationality, contact information, and college information. 2. It specifies the test center as Manila and that test results will be sent via postal mail. It also lists his top three medical school choices. 3. The form requires signatures from the applicant and his school head to certify his student status and ability to graduate from his undergraduate program by 2016-2017. It outlines policies on payment, test day procedures, and consequences of misinformation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    NMAT

    National Medical Admission Test


    IDENTIFICATION (ID) FORM
    (Must be SUBMITTED to the Examiner on the day of the test)

    Application No.: 1031705575


    HIMANSHU KUMAR SINGH
    Bank Reference No.: 2514266584
    Name of Applicant (name that will appear on your Answer Sheets and Examinee Report Form)
    1996-11-26 Male India Single
    Birthdate Sex Nationality Civil Status
    University of Perpetual Help System Dalta, Las Piñas City, Metro Manila (NCR)
    Name of College Graduating From
    Metro Manila (NCR) Philippines
    2 X 2 ID Picture
    State/Province of College Graduating From Country of College Graduating From
    AB in Psychology 2016-2017
    College Course (Bachelors Degree) School Year Graduating

    contact information
    109,ANDHRAMATH NAUR,PO-NEUR PS-ANDHRAMATH,MADHUBANI, BIHAR 847108 India
    Home Address
    Test Center: Manila
    2 GUJIO STREET , 2ND REVILLE VARDANT PAMPLONA TRES, Las Piñas City, Metro Manila (NCR) 1740 Philippines
    Test Date: March 26, 2017
    Mailing Address
    Results to be: Sent via postal mail
    +632-8157420 +63-9291121077 himanshu1118314@gmail.com
    Test results and NMAT ID information released
    to requesting medical schools? Yes Landline Mobile E-mail
    (For Foreign Applicant only)
    Medical School Choices:
    1. University of Perpetual Help System - College of Medicine P2012267 November 10, 2026 PATNA
    2. University of Perpetual Help Rizal - Jonelta Foundation School of Medicine Passport No Expiry Date Place of Issue

    3. Bicol Christian College of Medicine - Ago Medical School Foundation

    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________)
    PHP1900.00 on or before
    ___________________
    March 03, 2017 (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 ________________________________________________________________
    University of Perpetual Help System Dalta, Las Piñas City, Metro Manila (NCR)

    with a college (bachelors) degree of/in ____________________________________________________________


    AB in Psychology by the end of school year ______________.
    2016-2017
    He/She can apply for admission to any Philippine medical college in the next schoolyear ________________.
    2017-2018

    Signature & Printed Name of School Head Designation Date Signed

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