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GOETHE-INSTITUT / MAX MUELLER BHAVAN MUMBAI

REGISTRATION FORM | EXAMINATIONS

Mr. Ms.

First Name: ________________________________________________________________________________________

Surname: __________________________________________________________________________________________

Date of Birth (DD/MM/YYYY): ________________________ Place of Birth: _______________________

Address: _______________________________________________________________________________________________

___________________________________________________ Pincode: _____________________________________

Mobile: _________________________________ Phone: _______________________________________________

Email: ____________________________________________ Mother tongue: ____________________________________

I WISH TO REGISTER FOR EXAMINATION:

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VENUE DATE TIME

PAYMENT DETAILS

Demand Draft bearing no. ___________________________ for INR ____________________

(made payable to “Max Mueller Bhavan”)

Cash for INR ___________________ with following specifications:

2000 _______________________________________________________________________________________________

500 _______________________________________________________________________________________________

100 _______________________________________________________________________________________________

I hereby confirm that I have read, understood and accepted the “Exam
Guidelines”, “Terms & Conditions for Exam Administration” and “Exam rules and
regulations” as posted on the website www.goethe.de/mumbai.

Date: _____________________________________

Signature: ________________________________

Goethe-Institut / Max Mueller Bhavan Mumbai, K. Dubhash Marg, Kala Ghoda, Mumbai 400001
www.goethe.de/mumbai | Tel: +91 22 22027542 | exams-mumbai@goethe.de

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