NMAT

IDENTIFICATION (ID) FORM

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

National Medical Admission Test

Application No.:
Bank Reference No.:

1041604321
1126221269

ASHISH NAGRAJA SWAROOP

Name of Applicant (name that will appear on your Answer Sheets and Examinee Report Form)

1997-09-26
Birthdate

Male

India

Single

Sex

Nationality

Civil Status

Ago Medical and Educational Center - Bicol Christian College of Medicine, Legazpi City, Albay
Name of College Graduating From

2 X 2 ID Picture

Albay

Philippines

State/Province of College Graduating From

Country of College Graduating From

BS in Medical Technology

2015-2016

College Course (Bachelors Degree)

School Year Graduating

contact information
AGO MEDICAL AND EDUCATIONAL CENTER(MEDICAL SCHOOL) RIZAL STREET, OLD ALBAY,LEGAZPI CITY,ALBAY, Legazpi City, Albay 4500
Philippines

Home Address

Test Center: Manila

Test Date:

April 17, 2016

Results to be: Sent via postal mail

AGO MEDICAL AND EDUCATIONAL CENTER(MEDICAL SCHOOL) RIZAL STREET, OLD ALBAY,LEGAZPI CITY,ALBAY, Legazpi City, Albay 4500
Philippines

Mailing Address

+63-528205877

Test results and NMAT ID information released

to requesting medical schools? Yes

Landline

Medical School Choices:

(For Foreign Applicant only)

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

2. Bicol University - College of Medicine

N0267908
Passport No

+63-9233050897

ashishnagrajswaroop@gmail.com

Mobile

E-mail

June 14, 2025

BANGALORE

Expiry Date

Place of Issue

3. Emilio Aguinaldo College - College of Medicine

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.
PHP1900.00 on or before
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________)
April 01, 2016
___________________
(Philippine Standard Time).
Copy the Bank Reference No. found on the upper left portion of this Form and CEMs 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.
Applicants 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.
Ago Medical and Educational Center - Bicol Christian College of Medicine, Legazpi City, Albay
I hereby certify that the person in the picture above can graduate from ________________________________________________________________
BS in Medical Technology
2015-2016
with a college (bachelors) degree of/in ____________________________________________________________
by the end of school year ______________.

2016-2017
He/She can apply for admission to any Philippine medical college in the next schoolyear ________________.
Signature & Printed Name of School Head

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Designation

Date Signed