REQUEST FOR IELTS TEST REPORT FORM

TO BE SENT BY COURIER

Family Name
Other Name
Address for Correspondence

Telephone / Mobile No.

Email
Date of Birth

(dd/mm/yy)

_____ /_____ / _____

Gender (Please circle)

Male

Female

National ID/ Passport No.

Most recent test details
Centre No.

Centre Name

Candidate No.

Test Date (dd/mm/yy)

I certify that the information on this form is complete and accurate to the best of my knowledge and authorise the IELTS Test Partner to
send the Test Report Form to me via courier service.

_________________________

_________________

Signature of Candidate

Date (dd/mm/yy)

(Must be identical to the signature on the application form)

Courier Charges
Price inclusive of GST (MYR)
From KL & Penang
From Kuching
From Kota Kinabalu

TNT Courier
Zone 1 - In Country
Zone 2 - Singapore, Brunei, Indonesia
Zone 3 - Australia, New Zealand, China, Hong Kong
Zone 4 - UK, US, Canada
Zone 5 - Others

27.00
48.00
64.00
96.00
138.00

22.00
43.00
53.00
75.00
100.00

22.00
43.00
100.00
159.00
100.00

For Office Use Only

Received by
(CREs name)
TRF sent by
(Exams Staff)

Ground Floor, West Block, Wisma Selangor Dredging

142C, Jalan Ampang, 50450 Kuala Lumpur, Malaysia
Telephone: +60 (0)3 2723 7900
Email: kualalumpur.exams@britishcouncil.org.my

Date & Receipt No

Date

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