FUNCTIONAL SKILLS EXAM BOOKING 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 IMPORTANT NOTEPlease note that we take our exams on Monday, Wednesday, or Thursday at 11 am or 2 PM at our Forest Gate Branch. We take exams every day including weekends at our Ilford Branch ( Weekends exams start at 2 PM) If you would like to do your exams on any other day, please call us or email us! 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 NAMEfill out only if you want your middle name in your certificateSURNAME*ADDRESS LINE 1*ADDRESS LINE 2CITYPOST CODE*DATE OF BIRTH Date Format: DD slash MM slash YYYY GENDERMALEFEMALECONTACT NUMBER*EMERGENCY CONTACT NUMBEREMAIL* EXAM INFORMATIONEXAM INFORMATION*EXAM BOARDBRANCHEXAM LEVELSUBJECTFEESEXAM TYPE EDEXCELFOREST GATEILFORD- ONSCREEN EXAMS ONLYLEVEL 2LEVEL 2 RESOURCESLEVEL 1ENTRY LEVEL 3ENTRY LEVEL 2ENTRY LEVEL 1MATHSMATHS + ENGLISHENGLISHREADING ONLYWRITING ONLYMATHS & ENGLISHMATHS - £100MATHS RETAKE-£90ENGLISH -£140ENGLISH RETAKE -£120READING ONLY RETAKE-£70WRITING ONLY RETAKE-£70MATHS + ENGLISH - £240On PaperOn Screen What time would you like to start your exam?*11 AM2 PMChoose the dates you would like to book your exam for* Date Format: DD slash MM slash YYYY FOR ON PAPER EXAMS WE NEED 2 WEEKS NOTICE ( MINIMUM). FOR ON-SCREEN EXAM WE NEED 24 HOURS ( MINIMUM) SPECIAL ARRANGEMENTS AND NEEDSDo you require special access requirements during your exam?*YesNoPlease find our Access Arrangement Fees under GCSE or A -Level exam feesIf 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 specifyPlease provide the evidence Drop files here or Do 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 administration 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, bank transfer. The centre does not accept cheques as a method of payment. Refunds Please note that the centre cannot provide refunds once the exam has been booked. 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 TransferHow would you like to pay?Account Name: EDU SERVICE LIMITED Account Number: 14849157 Sort Code: 04-06-05 Total Payment* Credit Card Card Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.