Exam Registration Form

(Please read instructions in the mail carefully before filling the form)

Surname: _________________________________________________________________________________________

Given Names: ____________________________________________________________________________________

Please paste a
digital passport Participation no.: _________________________________________________________________________________
sized photo
Date of Birth (DD/MM/YYYY): ________________________ Place of Birth: ______________________________

Nationality: ______________________________________ Phone: ______________________________________

Insert a passport size photo
in the space above
Email ID: __________________________________________________________________________________________

Level Fee Date Time

(Written) (Verbal)
Goethe- Internals
Zertifikat A1 INR 5200 12.12.2022 9.45 a.m. to 10.50 a.m. 11 a.m. onwards

I hereby confirm that I have read and understood the “Exam rules and regulations” as posted on the
website and agree to abide by the same https://www.goethe.de/ins/in/en/sta/ban/prf/anm.html

Signature of the student: ________________________________________ Date: ___________________________

Model test papers for practise can be found here: https://www.goethe.de/ins/in/en/sta/ban/prf.html

Exam results can be checked by logging into “Mein Goethe.de” on the website

Goethe-Institut / Max Mueller Bhavan german-exams-bangalore@goethe.de

716, CMH Road, Indiranagar 1st Stage, Bangalore – 560 038 www.goethe.de/bangalore

DECLARATION OF CONSENT UNDER DATA PROTECTION LEGISLATION

For certain visa application procedures (e.g. immigration of spouses, study etc.), the German diplomatic missions abroad require
proof of the applicant's knowledge of German and, if appropriate, additional information to verify the certificates provided. By
submitting this Declaration of Consent, the candidate gives his/her consent for the following personal information and
information about the examination taken to be provided to the relevant diplomatic mission:
Personal information (name, date of birth), copies/scans of passport, photo of the candidate, details of examination taken
(certificate number, examination result, examination registration documents, examination documents)
--------------------------------------------------------------------------------------------------------------------------------------
The candidate may withdraw his/her consent at any time with future effect.
Consent is given voluntarily. If it is not given or is revoked, the candidate may nevertheless take the examination. The
candidate declares the following in this connection:

"I ______________________________________________________________________________ (full name) hereby give the Goethe Institute,

Bangalore permission to provide the personal information and information about the A1 Level examination I have taken
specified above to the German Embassy / the German General Consulate in India for verification in the visa application
process."

Place: ________________________________ Date: ____________________ Signature: ____________________________________________