NMAT REGISTRATION FORM
National Medical Admission Test (This Form will NOT be collected on test day)
Application No.: 1017050122 MANALOTO, LEE KEIAH NICOLE REYES
Reference No.: C62QJV88 Name of Applicant
(Name that will appear on your Examinee Report Form)
2000-06-01 Female Philippines Single
Birthdate Sex Nationality Civil Status
4000 REYES COMPOUND, SAN DIEGO, SAN PABLO CITY, LAGUNA 4000 Philippines
2 X 2 ID Picture Mailing Address (Address where your Examinee Report Form will be delivered)
N/A +63-9510581195 [Link]@[Link]
Landline No. Mobile No. Email Address
FOR FOREIGN APPLICANT
Passport No. Expiry Date Place of Issue
Test Location: Domestic
Test Date: October 29, 2022 7AM to 11AM
REMINDERS
A. PAYMENT
1. Payment instructions have been sent to your official email address. Please pay the exact amount indicated in your payment
instructions.
2. Only successfully paid applicants will be able to take the online NMAT. Make sure that applicable fees have been settled on or before
the date and time indicated in your payment instructions. Payment made beyond the holding period will not be honored.
3. Confirm the details of your transaction receipt. Keep the copy of proof of payment for future reference.
4. A surcharge fee of Php200.00 will be collected to process refund request due to over or double payment and processing of any special
request or correction (i.e. change of mailing address etc.)
B. REQUIRED DOCUMENTS
1. Email a PDF file of Transcript of Records (for graduate applicants) or Certificate to Graduate (for graduating applicants) to
nmatrequirements@[Link] . Indicate in the subject line the following format:
Application Number_Complete Name_Scheduled Test Date.
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2. For updates, visit the website at [Link]/nmat.
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