PhiLSAT IDENTIFICATION (ID) FORM

Philippine Law School Admission Test (Must be SUBMITTED to the Watcher on the day of the test)

Application No.: 2041701873

Bank Reference No.:
2 X 2 ID Picture
3621918170 KEITH PORCARE RABINA
Name of Applicant (Name that will appear on your Answer Sheet and Certificate of Eligibility)
1988-03-04 Male Philippines Single
Birthdate Sex Nationality Civil Status
Caraga State University - Main, Butuan City, Agusan Del Norte
Name of College Graduated From
Agusan del Norte Philippines
State/Province of College Graduated From Country of College Graduated From
BS in Computer Science 2013-2014
College Course (Bachelors Degree) School Year Graduated

contact information

APARTMENT NO. 9, 1ST STREET, GUINGONA J.P. RIZAL, Butuan City, Agusan del Norte 8600 Philippines
Test Location: Cagayan de Oro City
Home Address
Test Date: April 16, 2017 COMMISSION ON AUDIT REGIONAL OFFICE XIII, SOUTH MONTILLA BLVD. VILLA KANANGGA, Butuan City, Agusan del Norte 8600
Results to be: Sent via postal mail Philippines
Mailing Address
Contact information released to requesting
law schools? Yes N/A +63-9209799138 coarabina@gmail.com
Law School Choices: Landline Mobile Email

1st: Xavier University - Ateneo de Cagayan Foreign applicant

2nd: Mindanao State University - Iligan City
3rd: Father Saturnino Urios University Passport No. Expiry Date Place of Issue

FOR THE PhiLSAT APPLICANT

1. 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 PhiLSAT website www.cem-inc.
org.ph/philsat, including, among others, the PhiLSAT policies on allowed and prohibited items, on cheating or improper test-taking behaviour in any manner
or form, and on failure to take or complete the test on the test date and testing location 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 PhiLSAT or
invalidation of my PhiLSAT results.

Applicants Signature Date Signed

2. Bring this Form to the nearest Bank of the Philippine Islands (BPI) branch and pay the total of PhiLSAT Testing Fee (PhP________)
PHP1000.00 on or before
_______________________.
April 03, 2017

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.
3. Check your email (including your spam mailbox) after two (2) business days for your payment confirmation e-mail. You must also visit the PhiLSAT website
to verify the status of your PhiLSAT application.
4. Visit the PhiLSAT website two weeks before the test date to know your room assignment and to download your Examination Pass.
5. Secure from the office of your College/University Registrar an official Certification that you graduated from the college/university with the college degree
course and in the school year indicated on this Form. You must have this Certification duly notarized by a notary public.

On the day of the test, you must bring and submit to your Watcher, the Notarized Certification from your
College/University Registrar and this PhiLSAT ID Form. Your PhiLSAT results shall be withheld indefinitely if
you fail to submit any of these two requirements.

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