CAMBRIDGE INTERNATIONAL EXAMINATIONS

IGCSE APPLICATION FORM – JUNE SERIES – 2023

CENTER MY372

Instructions: Please submit the following items together with this form to the front
counter:
a. One (1) copy of IC (Malaysian) or Passport (non-Malaysian).
b. One (1) copy of recent passport size photo (white or blue background).
c. Exam fees payment receipt generated by school cashier.
Payment can be made by Cash, Credit Card, Cheque (payable to UCSI
INTERNATIONAL SCHOOL SDN. BHD.) or Online Banking Transfer (Maybank
5147-8501-6462, UCSI INTERNATIONAL SCHOOL SDN BHD)

REGISTRATION DEADLINE: FRIDAY, 20TH JANUARY 2023

INSERT Candidate Number:

CANDIDATE’S (to be filled in by the Exam Officer)
PHOTO HERE
(Softcopy / hardcopy
acceptable)

1 . F u l l Name (As per IC / Passport) (in UPPPERCASE):

(THIS NAME WILL APPEAR ON YOUR ACTUAL RESULT CERTIFICATE)

2. Date of Birth / / (DD/MM/YYYY) Gender (please tick)

 Female  Male
3. IC (Malaysian) / Passport No.:_________________________

4. C o r r e s p o n d i n g A d d r e s s : ______________________________________________

_________________________________________________________________________

___________________________________________________________________________

5. Student’s Mobile No: ____________________ Parents Mobile No: ________________________

6. Candidate’s personal email (not school email): _______________________________________

7. Parent’s email: _________________________________________________________________

8. Is English your first language?  Yes  No

9. Class (tick appropriate box) :  10 A  10 B

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 CAMBRIDGE INTERNATIONAL EXAMINATIONS
IGCSE APPLICATION FORM – JUNE SERIES – 2023

Instructions: Please tick the syllabus(s) for the IGCSE examination.

The exam fees for inclusive of courier charges to the UK is RM800/Subject.

(✓) to SYLLABUS NAME SYLLABUS OPTION CODE Extended/Core
select CODE (Components)
First Language English 0500 BS Extended
(12,22)
English as a Second Language 0510 FY Extended
(Speaking Endorsement) (22,42,52)
First Language Malay 0696 A Extended
(01/02)
Foreign Language Malay 0546 Z Extended
(03, 13, 23, 43)
Chinese as Second Language 0523 A Extended
(01,02,03)
Mandarin Chinese 0547 Y Extended
(03,12,22,42)
First Language Chinese 0509 AZ Extended
(13,23)
Mathematics (Without 0580 BZ Extended
Coursework) (Extended) (23,43)
Additional Mathematics 0606 AY Extended
(12,22)
Combined Science (Extended) 0653 CY Extended
(22,42,62)
Physics 0625 CY Extended
(22,42,62)
Biology 0610 CY Extended
(22,42,62)
Chemistry 0620 CY Extended
(22,42,62)
Information & Communication 0417 AZ Extended
Technology (13,21,31)
Computer Science 0478 AY Extended
(12,22)
Business Studies 0450 Y Extended
(12,22)
Economics 0455 Y Extended
(12,22)
Accounting 0452 AY Extended
(12,22)
Art and Design 0400 C Extended
(01,02)
Global Perspectives 0457 AZ Extended
(13,02,03)
Note: Exam Fees = total selected syllabus X RM800
Example: 8 selected syllabus x RM800 = RM6,400.00

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 CAMBRIDGE INTERNATIONAL EXAMINATIONS
IGCSE APPLICATION FORM – JUNE SERIES – 2023

About You
Candidate’s Full Name
(in UPPERCASE)
Date of birth (DD/MM/YY) Mobile Number

Current Address
(including post Code)

Email address

Your Declaration

I understand that:

1.If I take a Cambridge International Examinations assessment, you will pass information about
me to Cambridge International Examinations, who will use the information I have provided to
process exam entries and results, or for other examination-related activities such as standards
setting, maintaining the integrity of assessments or to identify plagiarism, and for record keeping
purposes.

2.The information you share about me may include sensitive personal information, for example
information relating to a medical condition.

3.Cambridge International Examinations may disclose my personal data or sensitive personal

data to other departments within the University of Cambridge or to trusted third parties including
but not limited to universities and the Universities and Colleges Admissions Service (UCAS).
Cambridge may use and share anonymized data (that is, data that does not identify me) and
pseudonymised data (that is, data that is anonymous to the people who receive it) with trusted
third parties for research purposes.

4.In sharing my information, Cambridge International Examinations may transfer information

about me outside of the European Economic Area (EEA), for example for processing exam
entries and results, and to provide customer services support.

I declare that I have read and understood the information on this form, and I give explicit consent
to the use of information about me as outlined above.

Signature of Applicant:(or Guardian if

candidate is under the age of 18):
Date (DD/MM/YY)

For more information about how Cambridge International Examinations may use information about
you, please contact University of Cambridge Local Examination Syndicate, 1 Hills Road, Cambridge,
CB1 2EU, United Kingdom, tel: 0+44 1223 553311, email: info@cambridgeassessment.org

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 CAMBRIDGE INTERNATIONAL EXAMINATIONS
IGCSE APPLICATION FORM – JUNE SERIES – 2023

Declaration

I, __________________________________(candidate’s in full name) have

confirmed that the details filled in this form are accurate and I understand that any
changes made after the registration form have been submitted to Cambridge will be
charged a penalty fee including a new registration fee. There will be no refund
from Cambridge for any withdrawal after the submission deadline. No
replacement/reschedule/re-sit/refund if failure to take the examinations as per
scheduled. Only with Principal’s permission will they be exempted from sitting
however the student transcript will show they didn't sit the examinations.

Candidate’s Signature: ___________________

Date ____ /_____/______ (dd/mm/yy)

Parent’s Name and Signature:

Name: Signature: Date:

For Office Use

Form Received Date: __________________

(Tick) Submitted:

 1x copy of IC or Passport
 1x recent passport size photo
 Parent’s Signature
 Payment Receipt copy / Bank in slip

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