NATIONAL INSTITUTE OF ACCOUNTING TECHNICIANS IN THE PHILIPPINES

505 East Tower, Philippine Stock Exchange Center, Ortigas, Pasig City

Attach 1x1 ID
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Tel. No. (632) 6342204 or (632) 3860191 Fax No. (632) 7062212

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Website: www.niat.edu.ph info@niat.edu.ph

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INTERNATIONAL CERTIFICATION APPLICATION FORM

PERSONAL DATA

Student
Professional

Arancillo
Mr./Ms./Mrs./Miss/Dr. ______________ Last/Family Name/Surname: ____________________________________________

First/Given Name:

Raymond
Lopez
________________________
Middle Name: ____________________________
Suffix: _____________

01 / ____
09 / ____
Date of Birth (mm/dd/yyyy): ____
/
1991
CONTACT INFORMATION

APPLICATION CHECKLIST
Duly filled up application form
Application/Membership Fee
Signature
CV
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

BACHELORS DEGREE

2014
Year: __________________

BS Accounting Technology
Course: ______________________________________________________________
University of San Agustin
University: ____________________________________________________________

MASTERAL DOCTORAL

Year: __________________

Course: ______________________________________________________________
University: ____________________________________________________________
CPA

License No.: __________________________ Year: __________________

East West Educational Specialist

NIAT TRAINING PROVIDER: _____________________________________________

PAYMENT INFORMATION

NIAT Membership (Including courier fee)

New PHP1300
Renewal PHP1300

CAT Level 1 Package (including NIAT membership and courier fee)

New PHP4300
Renewal PHP4300

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)

CAT Level 3 (including NIAT membership and courier fee)

AUS
New PHP7300
Renewal PHP8300
CND
New PHP7300
Renewal PHP7300

Association of Accounting Technician (AAT-UK)

PHP8300

For NIAT Member ONLY:

CAT Level 1 PHP3300
CAT Level 3 (AUS) PHP6300

CAT Level 2 PHP6300

CAT Level 3 (CND) PHP6300

PAYMENT OPTIONS
1.

Direct deposit at any BDO branches:

Please indicate COMPLETE mailing address and contact numbers.

Villa Anita Dormitory Room 3 Fortunato St. Brgy. Villa Anita
Home / Bldg. No., Street: _________________________________

_____________________________________________________
_____________________________________________________
Iloilo
__________________________________ City: _______________
Iloilo
5812
Province: ____________________
Postal Code: ______________

Phone Number (Home): __________________________________

Phone Number (Office): __________________________________
razerdeath@yahoo.com
E-mail Address: ________________________________________
raylopezarancillomicb@gmail.com
Alternate E-mail Address: ________________________________

09162541766
Mobile Number: ________________________________________
09185459228
Alternate Mobile Number: ________________________________

Note: Please contact NIAT Office immediately for any changes on your contact
information to ensure timely delivery of membership documents.

DELIVERY OF CERTIFICATE AND ID

1.

All membership IDs and certificates shall be delivered via

courier services.

Certificates and NIAT Membership IDs shall be delivered

by LBC.

2.

All return to sender documents shall be at LBCs safekeeping.

Members shall be advised to schedule pick up at the nearest
LBC branches within 3 days. NIAT shall not be liable for any
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 _____________________________________________________
OFFICIAL USE ONLY:

Date: _____________________________________________________
APPLICATION RECEIVED ON: __________________

INVOICE NO. ________________ INVOICE DATE: ___________________________

COMPLETED REQUIRED DOCUMENTS

OR NO. ____________________ DATE PAID: ______________________________

APPROVED

MEMBERSHIP NO. ______________

DCR NO. ___________________ VERIFIED: _______________________________

NOT APPROVED

REASON: _____________________