NATIONAL INSTITUTE OF ACCOUNTING TECHNICIANS IN THE PHILIPPINES

Attach 1x1 ID
505 East Tower, Philippine Stock Exchange Center, Ortigas, Pasig City
picture with
Tel. No. (632) 6379375 or (632) 3860191 Fax No. (632) 7062212
Website: www.niat.edu.ph info@niat.edu.ph
white
background

INTERNATIONAL CERTIFICATION APPLICATION FORM

PERSONAL DATA
Student
MS. GOMOBAR
Mr./Ms./Mrs./Miss/Dr. ______________ Last/Family Name/Surname: ____________________________________________
CRISTINE TABAQUE
First/Given Name: ________________________ Middle Name: ____________________________ Suffix: _____________
x Professional
05 / ____
Date of Birth (mm/dd/yyyy): ____ 11 /1994
____ /

APPLICATION CHECKLIST CONTACT INFORMATION

x Duly filled up application form

x Application/Membership Fee Please indicate COMPLETE mailing address and contact numbers.
x Signature 00378, ALAMADA STREET,
Home / Bldg. No., Street: _________________________________

x CV
POBLACION 2
x Soft Copy of Academic Credentials (any of the following): College Diploma, _____________________________________________________
Transcript of Records, PRC ID/Board of Accountancy Certificate, Other Supporting Documents
_____________________________________________________
EDUCATION & PROFESSIONAL INFORMATION
PIGCAWAYAN
x BACHELORS DEGREE
2015
Year: __________________
__________________________________ City: _______________
BACHELOR OF SCIENCE IN ACCOUNTING TECHNOLOGY COTABATO 9412
Course: ______________________________________________________________ Province: ____________________ Postal Code: ______________
ATENEO DE DAVAO UNIVERSITY
University: ____________________________________________________________
x MASTERAL DOCTORAL Year: 2017
__________________ Phone Number (Home): __________________________________
MASTER IN BUSINESS ADMINISTRATION
Course: ______________________________________________________________
NOTRE DAME OF MIDSAYAP COLLEGE Phone Number (Office): __________________________________
University: ____________________________________________________________
cristygomobar@gmail.com
CPA License No.: __________________________ Year: __________________ E-mail Address: ________________________________________
NIAT TRAINING PROVIDER: _____________________________________________ cristpgomobar@gmail.com
Alternate E-mail Address: ________________________________
PAYMENT INFORMATION 09071205429
Mobile Number: ________________________________________
NIAT Membership (Including courier fee)
09260286375
New PHP1300 x Renewal PHP1300 Alternate Mobile Number: ________________________________
CAT Level 1 Package (including NIAT membership and courier fee)
New PHP4300 Renewal PHP4300 Note: Please contact NIAT Office immediately for any changes on your contact
information to ensure timely delivery of membership documents.
CAT Level 2 Package (including NIAT membership and courier fee)
New PHP7300 Renewal PHP8300
CAT Level 3 (including NIAT membership and courier fee)
New PHP3300 (Philippines) DELIVERY OF CERTIFICATE AND ID
CAT Level 3 (including NIAT membership and courier fee)
AUS New PHP7300 Renewal PHP8300 1. All membership IDs and certificates shall be delivered via
CND New PHP7300 Renewal PHP7300 courier services.
Association of Accounting Technician (AAT-UK)
PHP8300 Certificates and NIAT Membership IDs shall be delivered
For NIAT Member ONLY: by LBC.
CAT Level 1 PHP3300 CAT Level 2 PHP6300
CAT Level 3 (AUS) PHP6300 CAT Level 3 (CND) PHP6300
2. All return to sender documents shall be at LBCs safekeeping.
Members shall be advised to schedule pick up at the nearest
PAYMENT OPTIONS LBC branches within 3 days. NIAT shall not be liable for any
1. Direct deposit at any BDO branches: loss, damage, or delay in delivery of the documents and IDs.
Bank name: BDO
Account name: National Institute of Accounting Technicians of the Philippines,
Inc.
Account No.: 343-006-8384

2. Payment at NIAT office.

ACCEPTANCE OF SUBSCRIPTION
I declare that all of the information contained in this application is true and correct and I agree to provide any supporting documentation requested by the Institute. If accepted, I
agree to abide by the National Institute of Accounting Technicians Code of Professional Conduct and Continuing Professional Education requirements. I understand that I must
renew my subscription annually to enjoy the services provided by the Institute including eligibility privileges and retention of professional designation.

Signature _____________________________________________________ Date: _____________________________________________________

OFFICIAL USE ONLY: APPLICATION RECEIVED ON: __________________

INVOICE NO. ________________ INVOICE DATE: ___________________________ COMPLETED REQUIRED DOCUMENTS
OR NO. ____________________ DATE PAID: ______________________________ APPROVED MEMBERSHIP NO. ______________
DCR NO. ___________________ VERIFIED: _______________________________ NOT APPROVED REASON: _____________________