TDP reg form 17 and under Global v6.2.rtf

Candidate test day photo registration and consent form
Centre Name: E-KU Institut JaIK
Centre Number: SK050
Centre Address: Piaristicka 2, 949 01 Nitra
Centre contact telephone number: 037/654 24 56, 037/654 24 52
Use this form if you are 17, or under 17, years of age.
Exam details:
Which exam do you want to take?
Paperbased
Computerbased
Cambridge English: Preliminary (PET)
Cambridge English: First (FCE)
Cambridge English: Advanced (CAE)
Cambridge English: Proficiency (CPE)
Cambridge English: Business Preliminary
(BEC Preliminary)
Cambridge English: Business Vantage
(BEC Vantage)
Cambridge English: Business Higher
(BEC Higher)
Cambridge English: Financial (ICFE)
n/a
Cambridge English: Legal (ILEC)
n/a
On which date do you want to take
the exam?
Identification (ID): If you are taking Cambridge English: Advanced in the UK, Asia, Africa and
Australasia you must record the type of acceptable photo ID used to register for the exam
and bring the same ID back for each Exam component otherwise you will not be allowed to
sit the exam. Your ID must be current (not expired) and have a photograph.
ID type that you will bring to the exam
ID number (e.g. if bringing your passport, what is
the passport number):
Expiry date of the ID listed above:
Candidate test day photo registration form
Version 6.2 17 and under: Global March
2016
Your details:
First
name:
Family
name(s):
Date of
birth:
Gender:
Email
address:
Phone
number:
Male
Female
Mobile/cell
phone number:
City/town:
Address:
Post/zip code:
Country:
This is the address that your certificate will be sent to. If you want your centre to send it to a
different address, please contact the centre directly.
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 test?
For studying abroad
For work
In which
country?
Other
Do you have any special requirements?
For example, modified materials for visual
difficulties, or special requirements
because of a medical condition.
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 a 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 form and for the date listed here. The candidate will bring a valid photo ID with them on the
test day, 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.
Candidate test day photo registration form
Version 6.2 17 and under: Global March
2016
The photo shall only be available to organisations/individuals that I agree to Cambridge English
Language Assessment 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.
Signature
Date
Parent/Guardian
Signature of candidate
Candidate test day photo registration form
Version 6.2 17 and under: Global March
2016