GCSE RETAKE COURSE BOOKING 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, this form is only for course booking. In order to book your exam please use this url: https://www.examcentrelondon.co.uk/exam-entry-form/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 INFORMATIONCOURSE INFORMATION*EXAM BOARDSUBJECTFEES EdexcelAQAOCRWJECCIEMATHS HIGHERMATHS FOUNDATIONENGLISH LANGUAGEMATHS HIGHER- £100MATHS FOUNDATION- £100ENGLISH LANGUAGE 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 CONDITIONS Please note that the centre cannot provide refunds once the place has been booked. We also cannot provide refunds if the candidate is absent Signature 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 TransferPlease note that you are paying a deposit of £100 per subject (non refundable) to secure your place. Your rest of the payment will be due first day of your lesson. Account Number: 86226384 Sort Code: 60-83-71Total Payment* Credit Card Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.