EXAMINATION REGISTRATION
International House London, 16 Stukeley Street, Covent Garden, London WC2B5LQ
Once completed send this form to with a copy of your passport/EU ID Card
Examination required (pleasetick only one, use a separate form for each exam):
Fees for 2016
Cambridge English: First (FCE) £135Cambridge English: Advanced (CAE) £140
Cambridge English: Proficiency (CPE) £145
Fees for 2017
Cambridge English: First (FCE) £145Cambridge English: Advanced (CAE) £150
Cambridge English: Proficiency (CPE) £160
Date of Exam:
First name (s):Family name(s):
These names must be the same as the names on your passport/National Identity Card and must appear in the same order.
Date of Birth: (DD/MM/YY) / / Gender: Male Female
Address in London:
Telephone Number: Email Address:
Permanent Address (where certificate will be sent 2 months after the exam):
Passport or National ID number:
(this must be the ID you will bring
with you on the exam day)
Country of birth:
Nationality:
Name of institution where you are doing a Cambridge English exam preparation course (leave blank if you are not doing a course)
Why are you taking the exam? For studying abroad in which country
For Visa purposes for which country
For work Other
Do you have any special requirements? For example, modified materials for visual difficulties, or special requirements because of a medical condition.
Yes – Please specify
No
Confirmation of your registration and details of the timetable for the examination days will be sent to you at least two weeks before the examination date. The speaking exam may take place on a separate date. All exams are paper-based.
Please note that the examination fees are non-refundable and non-transferable.
Are you 18, or over 18, years of age? Yes
No - please complete the box below
Declaration:
I understand that all individuals who want to take Cambridge English exam are required to agree to all of the Terms and Conditions (a copy of which has been provided by the centre).
I wish to be admitted for the selected Cambridge exam at the centre listed on this form and for the date listed here. I will bring a valid photo ID with me on the exam day(s), and I consent to have my photo taken by the centre on the day of the Speaking exam and/or the written papers. I agree for this photo to be held on the secure Cambridge English Language Assessment Results Verification site and viewed as set out below if I give my agreement.
Additionally, if I use my exam result for a Visa/immigration application I agree for the exam result to be available on other sites shown at: if I give my consent.
I hereby authorise the following to access my information (tick if appropriate):
UKBA
The photo shall only be available to organisations/individuals that I give my details to or that I authorise to view my result.
By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions for this exam.
Candidate Signature: Date:
Are you 17, or under 17, years of age? Yes – then you must get your parent/legal guardian to
complete this section:
Declaration:
I am the parent/legal guardian of the candidate named on this form and I give consent to this person taking the Cambridge English exam selected above.
I understand that all individuals who want to take Cambridge English exam are required to agree to all of the Terms and Conditions (a copy of which has been provided by the centre).
I agree to the candidate being admitted for the selected Cambridge English exam at the centre listed on this formand for the date listed here. The candidate will bring a valid photo ID with them on the test day(s) and, I consent to them having their photo taken by the centre on the day of the Speaking test and/or the written papers. I agree for this photo to be held on the secure Cambridge English Language Assessment Results Verification site and viewed as set out below if I give my agreement on behalf of the candidate.
Additionally, if the candidate is to use their exam result for a Visa/immigration application I agree for the exam result to be available on other sites shown at: if I give my consent on behalf of the candidate.
I hereby authorise the following to access my information (tick if appropriate):
UKBA
The photo shall only be available to organisations/individuals that I agree to the giving the candidate’s details to or authorise to view the candidate’s result.
By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions for this exam.
Parent/Guardian Signature: Date:
Candidate Signature: Date:
For Reception use only: Amount Paid: Date: Receipt No.:
Method of Payment: Signed (for Reception):
Cambridge Credit/Debit Card Payment form
Card Number:Valid From: / M / M / / / Y / Y / Expiry Date: / M / M / / / Y / Y
Issue Number: (if present) / Amount: / £
Card Security Code: / This is the last three digits of the number on the reverse of the card, on the signature strip.
Name as it appears the card:
Cardholder address:
Cardholder’s signature:
Date:
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