UNIQUE CANDIDATE IDENTIFIER NUMBER (UCI): Write CREATE NEW if you have NO UCI Number. Re-sitting examina-tions you MUST use previous UCI number from your Statement of Results provided from your school or previous exam centre

Examination Centre

Number: 20212

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PLEASE COMPLETE USING BLOCK CAPITALS Complete One Application Form Per Examination Series

Exam Application Form

Science Practical Endorsements

GCSE November May/June

International GCSE A Level May/June

January May/June

Title: Dr/Mr/Mrs/Ms/Miss:

Male/Female: Date of birth:

Surname: First Name:

Address:

Home Tel: ___________________________________ Mobile Tel:___________________________________ Email:(Capitals)______________________________________________________________________________

*Required for GCSE & A Level Modular Exam Units. Please indicate if you require the Examination Centre to “CASH- IN” all Units and issue a Full Grade for the subject and issue a final certificate. All exam units in your subject must have been

completed to cash-in and be awarded a final grade. Check your Subject Specification for Cash-In or Award Codes. If you do not request a “cash in” you will not RECEIVE an overall GCSE or A Level grade.

Post Code

ATTACH A NEW

PASSPORT SIZE

PHOTOGRAPH HERE

Functional Skills GCSE / IGCSE

A Level: Exam board AQA / OCR / Edexcel/ CIE:

Subject:

Exam Unit Code:

(Not subject code)

A Level Science Endorsements: (Dates on website)

* Enter Cash in Code:

(Not subject code)

Payment Fee:

e.g. A Level AQA Biology 7402 ——————- —————- £825.00

Distance Learning Provider: Student Number:

Total Fees

A “cash-in” code is not required for Linear Examinations and therefore leave blank

Have you taken exams at our centre before?

Rev Sept 2017

Functional Skills

On Screen

Select Exam Series

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Conditions of examination entries: It is your responsibility to ensure that the written examinations you want to be entered are available during the session indicated. You must ensure that the details provided are correct and that the exams do not clash with other examinations you take. You are strongly advised to verify the date and time of your examinations independently from the Examination Boards websites. The Statement of Entry that contains this information will be emailed or posted to you but delivery cannot be guaranteed. Refunds are not possible once examinations are booked and processed. Amendments after the examination board entry deadline will incur an additional fees of £99. Application received after the entry deadline will not be processed until late fees have been paid.

Application forms are required 3 days before the entry deadlines date.

I accept the conditions of the examination entries as outlined above.

SIGNED ……………………………………………………… ………………….. DATE………………………………

Please send the Application Form via the Post Office Recorded Delivery Mail to: English Maths Science Tuition & Exam Centre,

40 Showell Green Lane, Sparkhill, Birmingham, B11 4JP.

How did you discover our Examination Centre?

Search Engine, Google Ad, Distance Learning College, Exam Board Website, Leaflet/Magazine, Web, Personal Recommendation <<<<<<Please circle selection>>>>>>

Payment Method: please tick Cash at our centre only- prepaid——–——–———–— Cheque ———————————————————— Website Payment ( + 3% handling fee ) ——–————

Make cheques payable to: English Maths Science Tuition Centre Ltd To Pay by Credit or Debit Card go to: http://www.englishandmaths.com/examination-centre/

and click PAY NOW. (3% Handling fee applies as shipping)

DO NOT SEND CASH WITH THIS APPLICATION FORM VIA POST

Attach Page 1, 2 & 3 and post this completed examination entry form together with:

One NEW passport size photograph —————– A photocopy of your passport or driver licence — Payment or Confirmation of website payment —_

Page 4, 5, 6 & 7 are to be RETAINED and READ by the candidate sitting the examination

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