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NMAT

National Medical Admission Test


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

Application No.: 1101900094


GALLARDO, DARYL GARIMBAO
Card Transaction No.: 2070004573
Name of Applicant (name that will appear on your Answer Sheets and Examinee Report Form)
1994-12-16 Male Philippines Single
Birthdate Sex Nationality Civil Status
Our Lady of Fatima University (Fatima Medical Science Foundation) - Valenzuela, Valenzuela City, Metro Manila (NCR)
Name of College Graduated From
Metro Manila (NCR) Philippines
2 X 2 ID Picture
State/Province of College Graduated From Country of College Graduated From
BS in Medical Technology 2017-2018
College Course (Bachelors Degree) School Year Graduated

CONTACT INFORMATION
, PAGSAWITAN, SANTA CRUZ, LAGUNA 4009 Philippines
Home Address
Test Center: Manila
, PAGSAWITAN, SANTA CRUZ, LAGUNA 4009 Philippines
Test Date: October 27, 2019
Mailing Address
Results to be: Sent via postal mail
N/A +63-9353783544 gallardodaryl@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 the East - Ramon Magsaysay Memorial Medical Center
2. West Visayas State University - College of Medicine Passport No Expiry Date Place of Issue

3. Our Lady of Fatima University - College of Medicine

FOR THE NMAT APPLICANT


1.  Visit the NMAT website to verify the status of your NMAT application and to download the NMAT Practice Set.
2.  Visit the NMAT website at least a week before the test date to know your room assignment and to download your Examination Permit.
3.  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

Bring and submit also to your Examiner on the day of the test a photocopy of your official
Transcript of Records (TOR) issued by the College where you graduated from. Your NMAT
results shall be WITHELD indefinitely if you fail to submit a photocopy of your TOR and/
or this NMAT ID Form.

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