Disclosure: By accomplishing this Registration Form, the registrant hereby consents to the collection, processing and storing of personal

of personal data by Bureau of Education Assessment

for the exclusive purpose of facilitating his/her application for the Philippine Educational Placement Test (PEPT).

1. Download this form.

2. Fill it out.
3. Upload the accomplished form.
Republic of the Philippines
Department of Education
BUREAU OF EDUCATION ASSESSMENT

PHILIPPINE EDUCATIONAL PLACEMENT TEST

REGISTRATION FORM
Name of Last Name First Name MI
Registrant
(Pangalan ng
Mag-eexam)

Mailing Address

Email Address Date of Birth (MONTH/DD/YYYY | June/11/2007) Age Sex Contact Number

Female Male
LRN (if available) Date of Registration (MONTH/DD/YYYY | June/11/2007) Last Grade Level Completed Level you are registering for

Reason for Applying Is the registrant currently enrolled? ###

If Yes, indicate Grade Level:

Yes No ###
Name of School Last Attended

Address of School Last Attended

Examination Center/ Division Division Code

DEPED CENTRAL OFFICE - BEA BEA-EAD
I hereby declare under oath that I have personally accomplished this Registration Form and that by affixing my name below, I am certifying that all documents attached to this application is a faithful
reproduction of the original, and that all statements and information provided therein are complete, true and correct to the best of my knowledge. I am assuming full responsibility and accountability
on the correctness of the details provided and authenticity of the documents submitted. I am aware that any violation will automatically disqualify me and authorize the Bureau
of Education Assessment (BEA) to deny the transaction I applied for and forfeit payments rendered thereof.

Signature over Printed Name of Registrant

INSTRUCTIONS TO THE PEPT REGISTRANT AUTHORIZATION:

Accomplish the Registration Form. Do not leave any details blank. Write NA if NOT
applicable.
Strictly follow the registration instructions/procedures posted. Fill out the Google
Form through the link provided and upload this registration form in MS Excel together This is to authorize the person stated below to transact and settle
with other documentary requirements. application and shipping payments on my behalf.
Wait for an email from the BEA acknowledging your application and results of the
eligibility evaluation.
Be at the testing center on the day of your exam schedule and bring original copy of
all documents submitted for authentication purposes.
Wait for the shipping of Certificate of Ratings or pickup the test result at the BEA
office.
Signature over Printed Name of Authorized Representative

FOR THE EVALUATOR ONLY

(Do not answer this part)

Last Level Completed: Schedule of Exam:

Checklist & Requirements: Purpose of Exam:
Birth Certificate (Placement/Retake/Validation)
School Record (F137/SF10)
Remarks:
School Permit *
COR (For RETAKE only)
m Level/s to take:
Most recent 1x1 Photo
Indorsement Letter **
Proof of Payment
OR No. :

* For applicants from the private schools only Name & Signature of Evaluator / Date
** From the Regional/Division Office; for applicants from schools without Gov't permit
 By accomplishing this Registration Form, the registrant hereby consents to collecting, processing, and storing of personal data by the Bureau of Education Assessment
Disclosure: for the exclusive purpose of facilitating his/her application for the Philippine Educational Placement Test (PEPT).

1. Download and complete this form

2. Email the accomplished form to [email protected]
and wait for the payment details.
Republic of the Philippines
Department of Education
BUREAU OF EDUCATION ASSESSMENT

PHILIPPINE EDUCATIONAL PLACEMENT TEST

REGISTRATION FORM
Name of Last Name First Name MI
Registrant
(Pangalan ng
Mag-eexam)

Person With Disability (PWD)

Mailing Address
Yes No
Email Address (required) Date of Birth (MONTH/DD/YYYY | June/11/2007) Age Sex Contact Number
Female Male
LRN (if available) Date of Registration (MONTH/DD/YYYY | June/13/2022) Last Grade Level Completed Level you are registering for

Reason for Applying Is the registrant currently enrolled?

If Yes, indicate Grade Level:

Yes No
Name of School Last Attended

Address of School Last Attended

Examination Center/ Division Division Code

DEPED CENTRAL OFFICE - BEA BEA-EAD
I hereby declare under oath that I have personally accomplished this Registration Form and that by affixing my name below, I am certifying that all documents attached to this application
are a faithful reproduction of the original, and that all statements and information provided therein are complete, accurate, and correct to the best of my knowledge. I am assuming full
responsibility and accountability for the correctness of the details provided and document's authenticity. I am aware that any violation will automatically disqualify me and authorize the
Bureau of Education Assessment (BEA) to deny the transaction I applied for and forfeit payments rendered.

Signature over Printed Name of Registrant

INSTRUCTIONS TO THE PEPT REGISTRANT AUTHORIZATION:

Accomplish the Registration Form. Do not leave any details blank. Write NA if NOT
applicable.
Strictly follow the registration instructions/procedures posted. Fill out the Google
Form through the link provided and upload this registration form in MS Excel together I hereby authorize the person whose name is indicated below
with other documentary requirements. to transact and settle application and shipping payments on my behalf.
Wait for an email response from the BEA representative acknowledging your
application and the results of the eligibility evaluation.
Be at the testing center on the day of your examination schedule and bring the
original copy of all documents submitted for authentication purposes.
Wait for the shipping of Certificate of Ratings or pick up the test result at the BEA
office.
Signature over Printed Name of Authorized Representative

FOR THE EVALUATOR ONLY

(Do not answer this part)

Last Level Completed: Schedule of Exam:

Requirements: Purpose of Exam:
Birth Certificate (PSA/NSO/Local Civil Registrar) (Placement/Retake/Validation)
School Records (F137/SF10 with school seal &
signature of principal/registrar) Remarks:
Recent 1x1 Photo with name tag (colored)
PEPT Certificate of Rating (COR)
m (for applicants who need to retake a PEPT subtest)
Endorsement Letter from the DepEd Level/s to take:
Regional and Division Offices
(for applicants who completed their last level from a private school
without a government permit to operate)

Proof of Payment
OR No. : Name & Signature of Evaluator / Date
 Republic of the Philippines
Department of Education
BUREAU OF EDUCATION ASSESSMENT

PHILIPPINE EDUCATIONAL PLACEMENT TEST

EXAMINATION PERMIT
Name Surname First Name MI
of the
Learner 0 0 0 0
Contact No. Age Sex
Mailing
Address 0
0 0 0
Date of Birth LRN (if any) Date of Registration
December 30, 1899 0 December 30, 1899
Email Address Grade Level Passed

0 0
Name of School Last Attended

0
Address of School Last Attended

0
Examination Center Division Code
DEPED CENTRAL OFFICE - BEA BEA-EAD

Examination Schedule: Registration ID No. :

OR No.

On examination day, the test will start at 7:30 a.m. Bring a printed copy of this examination permit, scanned copy of Official
INSTRUCTION TO THE EXAMINEE Receipt, original copies of documents submitted online, a valid ID and 2 lead pencils.

EVALUATION REMARKS:

Certified True and Correct:

Name of Evaluator
Date/Time: