FOR OFFICE

Examination Registration Form

Please fill the form in CAPITAL LETTERS.

Customer Number 0 0 6 1 3 1 1 3 3 6
14/09/2022
Date of the Examination ______________________________

Examination

FIT 1 A2 FIT GZ A1 SD1 GZ A2

(below 17 years) (below 17 years)

✔ GZ B1 GZ B2 GZ C1 GZ C2 - GDS

Module (B1, B2 & C2 GZ Exam)

✔ Hören/Listening ✔ Lesen/Reading Schreiben/Writing Sprechen/Speaking

ANISHA ANTONY RAVI

First Name ______________________________________________ Last Name ________________________________________________________

15/10/1997 COONOOR
Date of Birth (DD/MM/YYYY) ___________________________ Place of Birth ______________________________________________________

INDIAN TAMIL NURSING

Nationality ____________________ Mother Tongue _____________________ Occupation ____________________________________________

Purpose to learn the Language:

Higher Education in Germany Family reunion in Germany

Business in Germany ✔
TO WORK IN GERMANY
Others - Please specify ____________________________

14/169 GARDEN HOSPITAL,NO.1 DIVISION

Address for communication ______________________________________________________________________________________________________
DEVARSHOLA ESTATE ,GUDALUR,THE NILGIRIS-643201
_____________________________________________________________________________________________________________________________________
9942947123 anishahoney1501@gmail.com
Mobile No.___________________________ EMail _______________________________________________________________________________________

I am interested to get information on a regular basis about upcoming courses and examinations. YES ✔ NO

Bank Name ______________________________________ Amount Transferred _____________________________________

Date of Transaction ______________________________ Transfer / Reference No. _________________________________

I have read the terms and conditions and accept the same.

29/08/202022
DATE ______________________ Signature _________________________________
 FOR OFFICE

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. lf 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:

ANISHA ANTONY RAVI

Hereby I, ______________________________________________________________________________________________________________
(First name and Last 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 India for counter checking for visa processing.

GUDALUR,29/08/2022
_______________________________ ___________________________________
Place, Date Signature

Please note:

• The examination fees are nonrefundable

• Kindly be at the center 45 minutes before the start of the exam
• All candidates must carry any ONE original ID proof for the exam
(Passport, Driving License, Voter's ID, PAN Card, Aadhar Card with complete Date of Birth)

Examination fee for year 2022
Examination Internal candidates **
Goethe-Zertifikat A1 Fit in Deutsch 1 Rs. 1400/-*
Goethe-Zertifikat A2 Fit in Deutsch 2 Rs. 1400/-*
Goethe-Zertifikat A1 Start Deutsch 1 Rs. 5200/-
Goethe-Zertifikat A2 Rs. 5200/-
Goethe-Zertifikat B1 ugendliche Rs. 4900/- (for 4 Modules)
Rs. 3000/- Per Module
Goethe-Zertifikat B1 Rs. 7600/- (for 4 Modules)
Rs. 3000/- Per Module
Goethe-Zertifikat B2 Rs. 7000/- (for 4 Modules)
Rs. 3000/- Per Module
Goethe-Zertifikat B2 ugendliche Rs. 4900/- (for 4 Modules)
Rs. 3000/- Per Module
Goethe-Zertifikat C1 Rs. 7600/-
Goethe-Zertifikat C2 GDS Rs. 11900/- (for 4 Modules)
Rs. 4100/- Per Module
GTPP-P ege Rs. 7600/- (for 4 Modules)
Rs. 3000/- Per Module
FOR STUDENTS
External candidates
Rs. 1400/-*
Rs. 1400/-*
Rs. 7600/-
Rs. 7600/-
Rs. 4900/- (for 4 Modules)
Rs. 4100/- Per Module
Rs. 12400/- (for 4 Modules)
Rs. 4100/- Per Module
Rs. 12400/- (for 4 Modules)
Rs. 4100/- Per Module
Rs. 4900/- (for 4 Modules)
Rs. 4100/- Per Module
Rs. 12400/-
Rs. 13500/- (for 4 Modules)
Rs. 5200/- Per Module
Rs. 12400/- (for 4 Modules)
Rs. 4100/- Per Module

** These examinations are available only to students studying in courses for teens.
Students currently taking part in language courses at Goethe-Institut, Chennai.

II. The Examination

Terms & Conditions
1. You are required to be present at the Goethe-Institut /
Examination Centre 45 minutes prior to the given examination
I. Registration time.

1. For examinations you will ha e to register online
Webshop.
2. The dates for the online registration and fee payment are
available on our website.
. Please fill in the re uested details carefully as this
information is necessary for the certificate.
ia 2. lt is mandatory for you to carry an Original Photo-ID on the
day of the examination. You will be allowed to take the
examination only after you show us the examination receipt
issued (by the Institut) for that particular examination and an
ORIGINAL ALID photo identification with your latest
photograph and the date of birth such as:. Passport /· PAN
Card/ Voter's ID Card/ Driving license / Aadhar Card (with
complete Date of Birth)

4. Once the registration has been done, the date of 3. Cell phones, watches (analog and digital). smart watches and
examination cannot be changed. However an exception can be any kind of electronic devices are not allowed during the
made in case of illness against a Medical certificate. In this case examination.
the fee would be transferred to the next available examination
date against deduction of 25% of the paid examination. 4. The date of announcement of the results shall be announced
on the date of the examination.
5. Exam fees, once paid, are non-refundable and
non-transferable. 5. The candidate can view the examination results online only.

. For bookings ia Webshop Webshop Terms Conditions are III. Certificates

applicable.
7. You are requested to read the Examination Guidelines and
Procedures available on our website carefully.
8. You will be considered as an internal candidate if you are
attending a course at Goethe-Institut at the time of registration
till 6 months from the end of the current course. All others are
considered as external candidates.
. For candidates with special needs there are special rules.
Please provide appropriate medical documentation for the
same at the time of the registration.
1. Examination certificates will be sent only through courier
within fifteen working days after the announcement of the
examination results. The candidate has to fill the correct
postal address on an envelope on the day of examination. If
the candidate fails to fill the en elope the Institute will not be
responsible for the certifiate.
2. The certificates will be issued according to the details in the
hall ticket. There is no possibility for any change once the
certificate is issued.
. In case of loss of certificate a replacement certificate shall
be issued against charges of INR 1000.
 FOR STUDENTS
Terms & Conditions
EXAMINATION LEVELS
IV. Viewing

1. You (minors in the company of a parent or guardian) may Goethe-Zertifkat C2:

inspect/view the examination paper, which you have taken in C2 GDS
the presence of an examination official/an examiner. Only
the applicable answer sheet and the evaluation sheet shall be
presented for the same. You are not allowed to take any
photographs or make copies during this process. No question
papers will be presented for the same and neither are you
entitled to any individual counselling.
C1 Goethe-Zertifkat C1

(a) For viewing of the examination papers

please write an email within 15 days from
the examination-result-declaration-date to Goethe-Zertifkat B2
pruefungen-chennai@goethe.de B2 (for adults and youth)
V. Liability of the Goethe-Institut / Max Mueller Bhavan

1. The liability of the Goethe-Institut / Max Mueller Bhavan

Goethe-Zertifkat B1
and its staff shall be limited to intent and gross negligence.
The Goethe-Institut / Max Mueller Bhavan will have no
B1 (for adults and youth)
liability for cancellation of its services due to force majeure
(e.g. natural disasters fire oods war official orders and all
other circumstances beyond the control of the contractual
parties). Goethe-Zertifkat A2
2. Grievances regarding examinations can be addressed to
the Language department through Email to
A2
che-deutsch@goethe.de Goethe-Zertifkat A2
Fit in Deutsch (for youth)
3. The terms and conditions are subject to change without
prior notice. For the latest version, please check the website.
Goethe-Zertifkat A1:
VI. Disclaimer
Start Deutsch 1
The number of available seats and examination dates are
only indicative. We reserve the right to change or modify the
A1
number of available seats and / or examination dates without Goethe-Zertifkat A1:
notice due to internal scheduling or administrative reasons or Fit in Deutsch 1 for youth
reasons pertaining to regulations stipulated by the Central or
State government.

Goethe Test PRO

PRO German for Professionals
A1 - C2

Test Deutsch als

TestDaF Fremdsprache
B2 - C1

Tel: +9144 2833 1644 / 2833 0645

German.Chennai@goethe.de
www.goethe.de/chennai