EXAM REGISTRATION FORM OUR DETAILSPLEASE CALL OR E-MAIL US IF YOU NEED ANY HELP WITH THE FORM PHONE: 02086162526 OR E-MAIL: lNFO@EXAMCENTRELONDON.CO.UK CANDIDATE'S PHOTO AND IDPHOTO* File uploadProvide your most recent passport size photographYOUR ID* File uploadPlease provide your ID ( Passport /driving licence/ or any other valid UK photo IDCANDIDATE DETAILSFIRST NAME*MIDDLE NAMESURNAME*ADDRESS LINE 1*ADDRESS LINE 2CITYPOST CODE*DATE OF BIRTH Date Format: DD slash MM slash YYYY GENDERMALEFEMALECONTACT NUMBER*EMERGENCY CONTACT NUMBEREMAIL* Do you have a UCI Number ( 13 digits )*YesNo(If it is a retake, you should have a UCI number) UCI NUMBER (13 Digit)Do you have a ULN number (10 Digits)YesNoULN NUMBERIf you previously sat an exam, You may have an ULN number. IMPORTANT DATES EXAM SERIES ENTRY DEADLINE LATE FEES CHARGE FROM HIGH LATE FEES CHARGE FROM NOVEMBER 2018 04/10/18 05/10/18 31/10/18 JANUARY 2019 20/10/18 21/10/18 21/11/18 JUNE 2019 21/02/19 22/02/19 22/04/19 EXAM INFORMATIONEXAM INFORMATION*EXAM BOARDEXAM SERIESTYPESUBJECTUNIT CODEOPTION CODEFEES EdexcelAQAOCRCambridge ( CIE)WJECJune 2019November 2019January 2020GCSEIGCSEA-Level Are you retaking these exams?*YesNoPlease specify which exams you are retaking?Are you caring forward your practical endorsement /course work/ spoken/ or any other assessment?YesNoPlease note that we are not offering any practical endorsement or course work. You are advised to choose the component which is alternative of above if necessary. Please Specify*Please provide the evidence* Drop files here or SPECIAL ARRANGEMENTS AND NEEDSDo you require special access requirements during your exam?*YesNoIf yes, please provide any evidence to support your need for access arrangements as required by the relevant awarding bodies?Please provide the evidence Drop files here or Do you suffer from any mental conditions such as high levels of anxiety?YesNoIf yes, please specifyDo you have any conditions or disability?YesNoIf yes, please specifyPlease provide the evidence Drop files here or Data Protection Act 1998: The information given on this form will be held electronically and as a hard copy for administratio purposes within Merit Tutors only and will be destroyed when the student leaves permanently. Date will be not disclosed to anyone external without your express written consent. Private candidates are required to take complete responsibility in being aware of the terms and conditions stated in this form. Merit Tutors cannot be held liable for any errors upon the completion of the form. TERMS AND CONDITIONSExam Fees Our exam fees can be found on the website or you can call us at 02086162526 We cannot make entries until we have received the full payment. We accept payment via cash, card or bank transfer. The centre does not accept cheques as a method of payment. Refunds Candidates may wish to withdraw from their examinations by e-mailing or calling us before the first deadline entry. We will refund the amount to you after deducting £30.00 per exam as administrative costs. Please note that the centre cannot provide refunds if after the first entry deadline have passed. We also cannot provide refunds if the candidate is absent from the examSignature Only candidates over the age of 16 may sign this form. If you are under the age of 16 please ask a parent/guardian to sign your behalf. I hereby confirm that I have read and understand the terms of conditions of the document. I declare the information given to be accurate to the best of my knowledge. I consent to my information to be shared with awarding bodies to enable exam entry\requirements to be fulfilled and other organisations if I require further services.NameSignatureIf you are not the candidate but the person responsible for the candidate please tell us the relationship.Date Date Format: DD slash MM slash YYYY PAYMENT METHOD*CardBank TransferCashHow would you like to pay?Account Number: 00030791 Sort Code: 20-45-45Please call or email us to book an appointment and pay at our centreTotal Payment Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name
