Cambridge IGCSE™, Cambridge IGCSE™ (9–1) and Cambridge O Level Art & Design Cover

Sheet
Please follow these instructions carefully before completing the PDF Cover Sheet provided below.

1 This form is an interactive PDF and may be completed in one of two ways:
• on-screen and then printed out
• printed out and completed on paper by hand.

2 Additional copies of this form can be downloaded from the samples database www.cambridgeinternational.org/samples

3 Completing the Cover Sheet:

• A cover sheet must be attached to the front of the work for each candidate.
• Please complete the information at the top of the form.
• Candidates complete Part A and the teacher responsible for the course completes Part B.

4 Please keep a copy of the Cover Sheet.

 Cover Sheet
Cambridge IGCSE, Cambridge IGCSE (9–1) and Cambridge O Level
Please select syllabus and component
–

You must send a completed Coursework Authentication Cover Sheet with each component submitted for assessment.

Candidates must complete Part A and the teacher responsible for teaching the course must complete Part B. Attach the completed forms to the front of
the relevant piece of work.

Part A

Centre number Centre name

Candidate number Candidate name

Exam series – Year

Candidate declaration: I confirm that the work submitted for this component is all my own work. I have not copied or based my work on any other work
that I have had access to. Any work taken from another source has been appropriately referenced and acknowledged.

Signed Date

Part B

Teacher declaration: I verify I have supervised sufficient work to enable me to sign this statement of authentication with confidence that this is the
candidate’s own work. The work has been fully checked and these checks included looking for:

copying from any other work

copying from other students

the possibility of a third person producing the work.

I also confirm that syllabus regulations on the role of the teacher have been observed.

Teacher comments (optional):

Continue on reverse if required

Signed Date

Teacher name