FOR OFFICE Registration Form Please fill the form in CAPITAL LETTERS. Any changes after submission will attr O salty of RS 1,00 Certificates will be prepared as per the information furnished GOETHE INSTITUT Internal Students: |D No. _ External Students: | have learnt German level Institut from _. DD No. _ _ (Only courier) Date of the Examination International Examination CFT? CAFIT2 Ooczaispi Ocza2 O26 Oz 82 oaa O GZ (2 - cbs Module (81 & C2 GZ Exam) 1] Lesen/ O Horen/ O1Schreiben/ 1 Sprechen/ Reading Listening Writing Speaking Surname Given Name Date of Birth ___ Place of Birth Occupation Nationality Mother Tongue Purpose to learn the Language: O Higher Education in Germany C1 Family reunion in Germany (1 Business in Germany CO Others - Please specify _ Have you appeared for this Examination before? Yes]. NoO If Yes, when. Address for communication _ Res. Telephone No. Mobile No. EMail | have read the terms and conditions of the examinations and accept the same. Date. SignatureFOR OFFICE O GOETHE INSTITUT Declaration of consent concerning data security Examinations conducted by Goethe-Instituts are recognized as a proof of language ability in the new Immigration Act for reunification of spouses in the visa process. In order to check the genuineness of the issued examination certificates while visa is being processed, the authorities concerned from the Ministry Of External Affairs have to obtain Name, Examination results and the certificate numbers of such examinees who have appeared and passed the exams for the visa purpose. By signing this declaration of consent for data security the examinee declares that he / she agrees to the passing of his / her personal data to the concerned authorities from the Ministry Of External Affairs. The examinee can revoke his / her declaration of consent for data security to be effective in the future The declaration of consent is voluntarily given on one's own accord. If the consent is not given or revoked, the authorities from Ministry Of External Affairs cannot check the genuineness of the Examination certificate with data available from Goethe- Institut. In such cases the onus of proving the validity of the certificate lies entirely ‘on the visa applicant. With this in mind the examinee declares the following: Hereby |, (Given & family name) Give permission to Goethe-Institut, Chennai to forward my personal data of the examination appeared by me such as my Name, my Examination result, the certificate number to the German Embassy / German Consulate in Chennai for counter checking for visa processing. Place, Date SignatureFOR STUDENTS, Examina' ee for year 2019 Examination Internal candidates “*| External candidates Goethe-Zertifikat At: Fit in Deutsch 1 = 1300/-* = 1300/-" Goethe-Zertifikat A2: Fit in Deutsch 2 = 1300/-* = 1300/-* Goethe-Zertifikat At: Start Deutsch 1 & 4500/- % 6600/- Goethe-Zertifikat A2 = 4500/- = 6600/- Goethe-Zertifikat B1 2800/- (Per Module) | % 3800/- (Per Module) %6300/- (4 Modules) | % 9000/- (4 Modules) Goethe-Zertifikat 81 Jugendliche %1500/-* (Per Module) | % 1500/-* (Per Module) © 4500/-* (4 Modules) | % 4500/-* (4 Modules) Goethe-Zertifikat 82 % 2800/- (Per Module) | % 3800/- (Per Module) %6300/- (4 Modules) %9000/- (4 Modules) Goethe-Zertifikat B2 Jugendliche % 1500/-* (Per Module) | % 1500/-* (Per Module) % 4500/-* (4 Modules) | = 4500/-* (4 Modules) Goethe-Zertifikat C1 % 6300/- 9000/- Goethe-Zertifikat C2: GDS % 3800/- (Per Module) | % 4800/- (Per Module) %9000/- (4 Modules) __| € 11500/- (4 Modules) Goethe Test Pro (Nachfolge zu BULATS) | % 4800/- = 4800/- “These examinations are available only to students studying in courses for teens. ~ Students currently attending language courses at Goethe-Institut, Chennai The examination fee has to be paid separately on the exam registration dates as per the schedule. jidates have ta bring their Receipt / Student ID, two photographs anc the | heduled dates, ailing ‘candidates have to appesr as external cand 2. Guidelines for External candidates: Online Portal opens at: 16:00 hrs on the E- Application Date Stea 1: On ion date cancidates are requested to register forthe examination using 1 http://www.goethe.de/ins/in/en/che.ntml only 2: Candidates will be selected on a first come first served basis and will be intimated through the registered e-mail ID on the mall date. exam fee on cnline portal are mandatory for regist + 2 passport size oh Course fee in Cash or DD ‘Candidates who have received a confirmation mail can send their documents through courier on or before the mentioned date. The Institute reserves all rights to reject the application for Missing documents incorrect dacuments/ documents received after the prescribed courier date. 3. Special arrangements can be mace inthe case of participants with special needs provided appropriate proaf ofthe need is documented at the time of exam registration fund / transfers. af the examination fee is possible 8 f eks of sults, All requests ar 50 ircumstar antral of the contractual par 0. 6 nina addressed to the Language department through Email to CHE-Deutsch@goethe.de The erm and condition ore subject ochange witht prior nlc. For elke verson plese check he webate