FUNCTIONAL SKILLS TUITION 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 CANDIDATE DETAILSFIRST NAME*MIDDLE NAMEfill out only if you want your middle name in your certificateSURNAME*DATE OF BIRTH Date Format: DD slash MM slash YYYY GENDERMALEFEMALECONTACT NUMBER*EMERGENCY CONTACT NUMBEREMAIL* TUITION INFORMATIONONE TO ONE TUITION*EXAM BOARDEXAM LEVELSUBJECTFEESEXAM TYPE EdexcelLEVEL 2LEVEL 1ENTRY LEVEL 3MATHSENGLISHICTREADING ONLYWRITING ONLYMATHS Level 2 4 hours- £100MATHS Level 2 8 hours- £180ENGLISH Level 2- 4 hours- £100ENGLISH Level 2- 8 hours- £180On PaperOn Screen 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 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 CONDITIONSSignature 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 Start Time : HH MM AM PM 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 NameThis field is for validation purposes and should be left unchanged.
