Cambridge English Examinations INDIVIDUAL REGISTRATION FORM Centre No: BG001 Candidate number: Please write in CAPITAL LETTERS OR TYPE. This form may be printed or photocopied. Registrations sent by fax or email cannot be accepted. The form must be signed, dated and submitted to us. Please tick the exam you wish to register for in one of the boxes below in the appropriate column (computer or paper-based), write the date of the exam, then complete the information on the front and the back page. WHEN ? Exam date: WHICH EXAM ? (Please cross the relevant box) PAPER- BASED COMPUTER- BASED FIRST CERTIFICATE IN ENGLISH (FCE) FIRST CERTIFICATE IN ENGLISH (FCE) FIRST CERTIFICATE IN ENGLISH (FCE) FOR SCHOOLS FIRST CERTIFICATE IN ENGLISH (FCE) FOR SCHOOLS CERTIFICATE IN ADVANCED ENGLISH (CAE) CERTIFICATE IN ADVANCED ENGLISH (CAE) CERTIFICATE OF PROFICIENCY IN ENGLISH (CPE) CERTIFICATE OF PROFICIENCY IN ENGLISH (CPE) KEY ENGLISH TEST (KET) PRELIMINARY ENGLISH TEST (PET) KEY ENGLISH TEST (KET) KEY ENGLISH TEST (KET) FOR SCHOOLS PRELIMINARY ENGLISH TEST (PET) PRELIMINARY ENGLISH TEST (PET) FOR SCHOOLS KEY ENGLISH TEST (KET) FOR SCHOOLS BUSINESS ENGLISH (BEC) PRELIMINARY PRELIMINARY ENGLISH TEST (PET) FOR SCHOOLS BUSINESS ENGLISH (BEC) VANTAGE BUSINESS ENGLISH (BEC) HIGHER BUSINESS ENGLISH (BEC) PRELIMINARY BUSINESS ENGLISH (BEC) VANTAGE BUSINESS ENGLISH (BEC) HIGHER TEACHING KNOWLEDGE TEST (TKT) MODULE INTERNATIONAL LEGAL ENGLISH CERTIFICATE (ILEC) INTERNATIONAL CERTIFICATE IN FINANCIAL ENGLISH (ICFE) TEACHING KNOWLEDGE TEST (TKT) MODULE Please choose SOFIA WHERE WOULD YOU LIKE TO TAKE THE EXAM ? (Please use numbers to indicate the order of your preferences) Important! Examinations Services may not be able to organise an exam session at your preferred town, if the number of registered candidates does not meet the Centre’s minimum entry requirements. You should indicate your 2nd and 3rd choices in case we are not able to organise the exam in a given town. The Centre reserves the right for a final decision on the choice of examination venues. Please choose VARNA Please choose STARA ZAGORA Please choose V. TURNOVO Please choose PLOVDIV Please choose PLEVEN Please choose BOURGAS Please choose ROUSSE OTHER PERSONAL DETAILS Gender–(Please tick ) Male Female Family name First and middle name(s) Date of birth: Date Month Year Passport/National ID card number (please state which) Postal address for correspondence Email address Telephone(s),mobile Post code: City/Town/Village: Parents’/Legal guardians’ contact number (if you are under 18) Where are you preparing for the exam? Do you know about dates when you cannot sit Speaking within the announced Speaking periods? Give a reason for each date given. The Centre may not be able to consider your preferences and reserves the right to schedule your speaking exam appointment on any of the dates within the official speaking exam window Do you have any special exam needs (hearing/visual impairments)? If yes, please state & support with medical documents. Please contact the Centre 3 weeks before the deadline for registration as additional forms and medical documentation are required Cambridge English Language Assessment holds the copyright on all question papers and examination material. Your answers and other work done by you as part of an examination are the property of Cambridge English Language Assessment and will not be returned to you, your school or centre. British Council is committed to deliver the examinations services according to the rules and regulations set by Cambridge English Language Assessment. However, we cannot be held responsible for any interruptions, which are caused by circumstances beyond our control. If examinations or their results are disrupted, cancelled, or delayed, every effort will be made to resume normal services as soon as possible and the British Council liability will be limited to the refund of the registration fee or re-testing at a later date. I wish to be registered for this examination and declare that: 1. I accept the Cambridge English Language Assessment regulations as outlined in the Summary Regulations for Candidates and the British Council arrangements. 2. I agree the British Council to pass on my personal data to Cambridge ESOL for the administration of the examination. 3. Only for candidates who are registered by their school of preparation: My personal details will be passed on to my school for statistical purposes. 4. Only for candidates who wish to be admitted for a paper-based or a computer-based session of KET*/PET/FCE/CAE/CPE/BEC/ILEC/ICFE: (for candidates under 18 an additional Parents’ / Legal guardians’ declaration of consent is required) I consent to have my photo taken by the centre on the day of the Speaking test and/or the written papers. I agree for this photo to be held on the secure Cambridge English Language Assessment Results Verification website, and the photo shall only be available to organisations/individuals that I give my details to or that I authorise to view my result. * Candidates for Cambridge English: Key will only be photographed if they want to use their result for immigration purposes and need a test day photo. If you are a KET candidate and you would like to use your result for immigration purposes, please tick the box and inform us at registration: 5. Additionally, if I use my exam result for a visa/immigration application I agree for the exam result to be available on other sites shown at http://www.cambridgeenglish.org/cambridge-english-for/visas-and-immigration/ if I give my consent. I hereby authorise the following to access my information (tick if appropriate): UKBA By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions of this examination. Signature Date: PAYMENT DETAILS (office use only) FEE amount in BG Lv: _________________________ Date of Payment _____/______/______ Cash Receipt Number: _________________________ (day / month / year) Bank Transfer Number:_________________________ ID checked (please tick) Signature of registering officer: