For Office Use only: Date received: Payment received: I.D. Document: Photograph: Private Exam Candidate Application Form Exam Series: Nov Jan May/June (delete) Surname Forenames NOTE: You must register using your full legal name as recorded on your birth certificate and passport. Date of Birth Title --/--/---- Mr/Mrs/Ms/Miss Address Please insert/paste a digital passport type photo into the Postcode box above. Or attach it to or paste into an email. Email address Telephone Number Mobile Number SEE NOTES: Unique Candidate Identifier 12-digits followed by – UCI Number a capital letter. Found on statements of entry or results. SEE NOTES: Unique Learner Number 10-digit number found – ULN Number on certificates or results slips. For office use only Candidate number Gender M or F Details of my required papers (It is the to check that the correct entry codes are supplied) candidate’s responsibility Re-sit Entry Cash-in code code Exam board Qualification Subject/Title Fee 1 Yes or No Y/N (+ tier of entry This will AQA , EDEXCEL, GCSE, IGCSE, H - higher or give you an OCR, WJEC or CIE GCE AS/A2 F-foundation overall AS GCSE/ IGCSE or A level only) grade. £ £ £ £ £ £ ANY OTHER CHARGES £ TOTAL FEE: £ I have entered examinations at this centre before. Yes/No
For Office Use only: Date received: Payment received: I.D. Document: Photograph: Private Exam Candidate Application Form Exam Series: Nov Jan May/June (delete) Surname Forenames NOTE: You must register using your full legal name as recorded on your birth certificate and passport. Date of Birth --/--/---- Title Mr/Mrs/Ms/Miss Address Postcode Please insert/paste a digital passport type photo into the box above. Or attach it to or paste into an email. Email address Telephone Number Mobile Number UCI Number SEE NOTES: Unique Candidate Identifier – 12-digits followed by a capital letter. Found on statements of entry or results. ULN Number SEE NOTES: Unique Learner Number – 10-digit number found on certificates or results slips. Candidate number For office use only Gender M or F Details of my required papers (It is the candidate’s responsibility to check that the correct entry codes are supplied) Exam board AQA , EDEXCEL, OCR, WJEC or CIE Qualification GCSE, IGCSE, GCE AS/A2 Subject/Title Re-sit Y/N Entry code (+ tier of entry H - higher or F-foundation GCSE/ IGCSE only) Cash-in code Yes or No This will give you an overall AS or A level grade. Fee 1 £ £ £ £ £ £ ANY OTHER CHARGES £ TOTAL FEE: £ I have entered examinations at this centre before. Yes/No