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Exam Registration Form

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

Given Names: ______________________________________________

PTNR No: __________________________________________________

Date of Birth (DD/MM/YY): ____________________________________

Place of Birth: _______________________________________________

Nationality: __________________ Phone: ____________________


Insert a passport size
Paste a passport size Email Id: ____________________________________________________
photo in the space
above

Level Date
Goethe-Zertifikat B2 Modular 10.02.2024

I hereby confirm that I have read and understood the “Exam rules and regulations” 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 practice can be found here: https://www.goethe.de/ins/in/en/sta/ban/prf.html


Exam results can be checked by logging into “http://trivandrum.german.in/result” on the website.
Goethe-Zentrum Trivandrum
D9, Jawahar Nagar,
Trivandrum, Kerala – 695003
exams@goethe-zentrum.org
Goethe-Zentrum Kochi Branch http://trivandrum.german.in
6th Floor, Chavara Cultural Centre, Monastery Road,
Near South Railway Station,
Kochi, Kerala- 673001
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DECLARATION

I hereby declare that I have read and understood all the terms and conditions given on the Goethe-
Zentrum website related to the admission, conduct of the examination and publication of the results.

I DECLARE THAT I WILL INSTRUCT MY PARENTS OR RELATIVES ACCOMPANYING ME TO THE EXAM


CENTRE IN TRIVANDRUM OR KOCHI NOT TO STAY OR CROWD IN FRONT OF THE EXAMINATION
CENTRE OR ON THE ROAD.

They will be asked to drop me at Centre and come back only after my exams are over.

I ACCEPT THE CONDITION THAT THIS IS MY SOLE RESPONSIBILITY AND IF MY PARENTS IR


RELATIVES DO NOT FOLLOW THIS AND CAUSE ANY INCONVENIENCE TO THE ZENTRUM OR ITS
NEIGHBOURHOODS, I SHALL BE DISQUALIFIED FROM ATTENDING THE EXAMINATION.

Date: Signature:

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