B11 B11

Exclusive copyright
Submit to: IB Cardiff Arrival date: 1 June / 1 December Session: ……….…

School number: 0 0

School name: .......................……....…………………………………………..…………..…..………..

Ž Write legibly using black ink and retain a copy of this form.
Ž List on this form the components for which the candidate claims exclusive copyright.
Ž The candidate must sign this form.
Ž The latest arrival date is 1 June/1 December, one week after the written examinations.

Candidate name:

Candidate session number: 0 0

Subject/theory of knowledge/extended HL/SL Component (please specify)*

essay

* for example, internal assessment, language A2 written task, language A1 world literature

Candidate’s signature: ..........................................................………… Date: ......…....…………..

Coordinator’s name (please print): …………………………………..

Coordinator’s signature: ……………………………………………... Date: ......…....…………..

© International Baccalaureate Organization 2008