Candidate Registration Form

Individual registration form

ESOL Center Number: MD002
The form must be signed, dated and submitted to us, at the Alliance Française de Moldavie.
Registrations sent by email or fax cannot be accepted.
Please tick the exam you wish to register for in one of the boxes below and in one of the appropriate columns
(computer-based or paper-based), write the date of the exam, then complete the information.

Use this form if you are 17, or under 17 years of age. You must complete all sections of this form.

Exam details:

Which exam do you want to take? Paper- Computer-

based based

Cambridge English: Key (KET)

Cambridge English: Key for Schools (KET fS)

Cambridge English: Preliminary (PET)

Cambridge English: Preliminary for Schools (PET fS)

Cambridge English: First (FCE)

Cambridge English: First for Schools (FCE fS)

Cambridge English: Advanced (CAE)

Cambridge English: Teaching Knowledge Test
n/a
(TKT Module 1)
Cambridge English: Teaching Knowledge Test
n/a
(TKT Module 2)
Cambridge English: Teaching Knowledge Test
n/a
(TKT Module 3)
Cambridge English: Teaching Knowledge Test: Content
n/a
and Language Integrated Learning (TKT: CLIL)
Cambridge English: Teaching Knowledge Test: Young
n/a
Learners

On which date do you want to take the exam?

Your details:

First name(s): Family name(s):

These names must be the same as those on your Passport/National Identity Card and must appear in the same order.

Date of birth: (day/month/year) Gender: Male: Female:

Email
address:

Phone
Mobile/cellphone number:
number:

City/town:

Address: Post/zip code:

Country:

Your certificate will not be sent to the address you indicate in this registration form. Certificates are sent to the exam centre,
where you come to pick them up with your Passport or National Identity Card (in original).

Name of the institution where you are doing or where you did a
Cambridge English exam preparation course (leave blank if you
are not or did not do such a course):

In which
Why are you taking the test? For studying abroad
country?
For which
For visa purposes
country?
For work

Do you have any special requirements? For example, modified

materials for visual difficulties or special requirements because
of a medical condition.

You only need to provide this information if you want to use your result for immigration in the future:

Passport or National ID number (must be valid):

Country of birth:

Nationality:
Declaration:

I am the parent/legal guardian of the candidate named on this form and I give consent to this person taking the Cambridge English
exam selected above.

I understand that all individuals who want to take a Cambridge English exam are required to agree to all the Terms and Conditions (a
copy of which has been provided by the center).

I wish to the candidate being admitted for the selected Cambridge English exam at the center listed on this form and for the date listed
here. The candidate will bring a valid photo ID with me on the test day, and I consent to them having their photo taken by the center on
the day of the Speaking test and/or the written papers. I agree for this photo to be held on the secure Cambridge English Language
Assessment Results Verification site and viewed as set out below if I give my agreement on behalf of the candidate.

Additionally, if the candidate is to use their exam result for a visa/immigration application, I agree for the exam result to be available on
other sites shown at http://www.cambridgeenglish.org/cambridge-english-for/visas-and-immigration/ if I give my consent on behalf of the
candidate.

I hereby authorize the following to access my information (tick if appropriate):

UKBA

The photo shall only be available to organizations/individuals that I agree to the giving the candidate’s details to or authorize to view the
candidate’s result.

By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions for this exam.

Signature Date

Parent/Guardian

Signature of candidate