**All fees are inclusive of GST PEARSON EDEXCEL INTERNATIONAL GCSE EXAMINATIONS (IGCSE) Centre Name MAY/JUNE 2016 PHOTO Affix your most recent passport size photo here (write your name at the back of the photo) FOR OFFICE USE ONLY Have you taken the examination before? YES / NO * (If YES, please provide the UCI number) UCI (Unique Candidate Identification) number Centre Number 94595 / 94598 Candidate Number Given Name (in BLOCK letters as per identity document) Full Address (for correspondence) B Surname / Family Name (in BLOCK letters as per identity document) Passport/IC Number Nationality Date of Birth (DD/MM /YYYY) Home Telephone Number Mobile Telephone Number Guardian Contact Number (MANDATORY for candidates below 18 years old) Gender Email Address (MANDATORY) May/June 2016 Examinations Registration Deadlines Normal Registration Date 16 th February 2016 to 13th March 2016 First Stage Late Entry 14th March 2016 to 3rd April 2016 Second Stage Late Entry 19 th March 2016 to 10 th April 2016 Checklist: Your completed entry form must be accompanied by the following (please tick): A recent coloured passport size photograph affixed to the entry form A copy of your passport or Identity Card The total examination fee A medical report for Access Arrangements (if applicable) Special Consideration: Access Arrangements Applications If you are a candidate with special requirements (Dyslexia, hearing difficulties etc.), please attach a medical report written in English to this application form. Candidates should make sure the report specifies the needs of the candidate for the examination (extra time, headphones etc.) Please tick here if you need Access Arrangements (please attach a supporting letter from a registered medical practitioner) V.2 Page 1
Subject and Unit Code (circle the Code you wish to register for) Component and Option Code (circle the Option code you wish to register for) (Standard) (Low late (High late Accounting 4AC0 01: Accounting 711.00 1,410.00 2,120.00 Arabic (First Language) 4AR0 Paper 1 & 2 Art and Design: Fine Art 4FA0 Paper 1 1,198.00 1,898.00 2,608.00 Bangladesh Studies 4BN0 Paper 1 & 2 Bengali 4BE0 01: Bengali 785.00 1,484.00 2,195.00 Biology 4B10 Paper 1 & 2 R Business Studies 4BS0 01: Business Studies 711.00 1,410.00 2,120.00 Chemistry 4CH0 Paper 1 & 2 R Chinese 4CN0 01: Listening 02: Reading & Writing R 1,347.00 2,131.00 2,905.00 Classical Arabic 4CA0 01: Classical Arabic 785.00 1,484.00 2,195.00 Commerce 4CM0 01: Commerce 711.00 1,410.00 2,120.00 Economics 4EC0 01: Economics R 711.00 1,410.00 2,120.00 English as a Second Language 4ES0 01: Reading & Writing 02: Listening R English Language Specification A 4EA0 Paper 1 & 2 AR English Language Specification B 4EB0 01: Specification B BR 785.00 1,484.00 2,195.00 English Literature French 4ET0 4FR0 Paper 1 Paper 2 Paper 1 Coursework 3(mark transferred from previous series) 01: Listening 02: Reading and Writing AR CR 711.00 1,410.00 2,120.00 1,347.00 2,131.00 2,905.00 Further Pure Mathematics 4PM0 Paper 1 & 2 Geography 4GE0 01: Geography 785.00 1,484.00 2,195.00 Global Citizenship 4GL0 Global Citizenship (paper 1) 711.00 1,410.00 2,120.00 Gujarati 4GU0 01: Gujarati 785.00 1,484.00 2,195.00 Hindi 4HN0 01: Hindi 785.00 1,484.00 2,195.00 History 4HI0 Paper 1 & 2 Human Biology 4HB0 Paper 1 & 2 Islamiyat 4IS0 01: Islamiyat 711.00 1,410.00 2,120.00 Mathematics Specification A 4MA0 Paper 1F & 2F Paper 3H & 4H FR Mathematics Specification B 4MB0 Paper 1 & 2 R Modern Greek 4MG0 01: Modern Greek 785.00 1,484.00 2,195.00 Pakistan Studies 4PA0 Paper 1 & 2 Physics 4PH0 Paper 1 & 2 R Religious Studies 4RS0 01: Religious Studies 711.00 1,410.00 2,120.00 HR V.2 Page 2
Subject and Unit Code (circle the Code you wish to register for) Science (Double Award) 4SC0 Component and Option Code (circle the Option code you wish to register for) Science Double Award (Biology, Chemistry, and Physics Paper 1) (Standard) (Low late (High late R 1,781.00 2,820.00 3,848.00 Sinhala 4SI0 01: Sinhala A 785.00 1,484.00 2,195.00 Swahili 4SW0 01: Swahili 785.00 1,484.00 2,195.00 Tamil 4TA0 01: Tamil 785.00 1,484.00 2,195.00 Turkish 4TU0 01: Turkish 785.00 1,484.00 2,195.00 Urdu 4UR0 01: Urdu 785.00 1,484.00 2,195.00 **All fees are inclusive of GST BREAKDOWN OF EXAMINATION FEES Total International GCSE exam fee payable in Ringgit to RM CANDIDATE DECLARATION 1. I make this entry according to the provisions of the published regulations which I have studied. 2. I agree that it is my responsibility to select the modular units that best meet my needs. 3. I have given all the information required truthfully and accurately to the best of my knowledge and belief. 4. I understand that I shall be allowed to sit only for those subjects and papers for which I have entered on this form. 5. I have not made an entry at any other examination centre. 6. I have not made any entry at any other Cambridge International Examinations centre. 7. I agree that there will be no postponement or refund of all fees should I decide to withdraw from the examination after registration. 8. I accept the responsibility to ascertain the place and date of the examination in case the official notification does not reach me on time CONSENT FOR EXAMINATION I, the undersigned, hereby agree and authorize the to disclose my personal data, such as my name, date of birth, gender, ID/Passport No., and information pertaining to this application to Pearson ( ) for purpose of providing and registering IGCSE/GCE O-Level/AS/A-Level examinations. I understand that any personal data provided by the to shall also be subject to s privacy policy. Signature of candidate: Date: For official use only Amount Paid Receipt Number Date of Payment Registered By Disclaimer The and the Examining Boards take all reasonable steps to provide continuity of service. We feel sure you will understand, however, that we cannot be held responsible for any interruptions caused by circumstances beyond our control. If examinations or their results are disrupted, cancelled or delayed, every effort will be made to resume normal service as soon as possible. The s liability will be limited to the refund of the registration fee or re-testing at a later date. V.2 Page 3
PAYMENT OPTIONS Transaction shall be made payable to BRITISH COUNCIL Office Submit to Cash Credit Card Bank Transfer Kuala Lumpur KL Office Penang Penang Office Terms of fee and payment: 1. Payment can be made to the either by cash, cheque, credit card, bank draft, or bank transfer. 2. Payment made to the respective office is subject to Bank s transaction terms and conditions. 3. Registration will be processed upon receipt and validation of the copy of the remittance slip which may be submitted by hand/courier together with the application form. 4. Payment via cash deposit must be made through the Citibank counter and not via a Cash Deposit Machine. 5. Payment description must be stated clearly. Bank Details: Payment Description : EDEXCEL MAY/JUNE2016 (Candidate s Name) Bank : Citibank Bank Swift Code : CITIMYKL Account Number : 0-115889-028 Completed application form is to be submitted by hand/courier to the office which you are registering to sit the examination as shown below: Ground Floor, West Block Wisma Selangor Dredging 142C Jalan Ampang 50450 Kuala Lumpur Tel. No.: 03 2723 7900 Fax No.: 03 2713 6599 E-mail: kualalumpur.exams@britishcouncil.org.my Counter opening times: Mondays to Fridays Saturdays & Sundays 9.00 am to 7.00 pm 10.00 am to 4.00pm www.britishcouncil.my www.edexcel.com Penang Centre Wisma Great Eastern Suite 3A.1 & 3A.2 25 Light Street 10200 Penang Tel. No.: 04 263 0330 Fax No.: 04 263 3262 E-mail: penang.exams@britishcouncil.org.my Opening times: Tuesdays to Sundays 9.00 am to 5.45 pm V.2 Page 4
PERMISSION FORM Dear Parent or Guardian, In order to ensure the safety of all candidates, we request signed parental consent for candidates to leave the examination venue without adult accompaniment. Please complete and return the form below to authorize your child to leave the examination venue unaccompanied by a parent or guardian following his or her exam sessions. Thank you for your cooperation in this matter. Exams Department I authorize my child,, to leave examination venue without adult supervision. Signature: Name: Date: V.2 Page 5