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YOUNG LEARNERS ENGLISH TEST REGISTRATION FORM

(FLYERS)
1. Candidate Name

........................................................................

2. School Name:

........................................................................

3. School Address

........................................................................

4. Date of Exam

........................................................................

5. Date of Birth

........................................................................

6. Mailing address

PHOTO stick here


(4x 6)

.........................................................................
.........................................................................

7. ID Card No

.........................................................................

8. Tel. Number

......................................... (home)

9. Email Address

.........................................................................................................................

........................................(mobile)

10. Have you ever taken UCLES exams before? If Yes, please state the exams name(s)
................................................................................................................................................................
I certify that the information on this form is complete and accurate to the best of my knowledge.
I understand that I will be present on the examination day....................... and bring my ID
Card/Passport as my identification evidence. I will follow all UCLES examination regulations as
requested.

Data Protection
The information you give on this application form will be used by the UD-UQ ELI to register with
Cambridge ESOL and maintain candidate records. The UD-UQ ELI may also use your personal
details to send you information on its activities. If you do not wish to receive this information please
tick the box below.
I do not want to get information

Signature of candidate............................................................

Date................................................

-------------------------------------------------------------------------------------------------------------------------For UD-UQ ELI Office Use Only


Scheme: _____________

Examination:

_________________

Exam Date: ....../..../...

Receipt No.:

_________________

Date of Payment:..../..../...

Cost set in USS$: ____

Administrators initials: __________

Amount received: ___________________________

Charging code: ________