PEARSON EDEXCEL Centre Name INTERNATIONAL GCSE EXAMINATIONS (IGCSE) JANUARY 2019 PHOTO Affix your most recent passport size photo here (write your name at the back of the photo) FOR OFFICIAL USE ONLY Centre Number 94595 (Kuala Lumpur) 94598 (Penang) Candidate Number Given Name (in BLOCK letters as per identity document) UCI (Unique Candidate Identification) number Have you taken the Edexcel examination before? YES / NO * (If YES, please provide the UCI number available in previous result slip) B Surname / Family Name (in BLOCK letters as per identity document) Current School Name School Address Education Level Full Address (for correspondence) Passport/IC No.: Nationality: Email(mandatory): Home Telephone No: Hand Phone No: Guardian Tel no.(mandatory for candidates below 18years old): Gender: Date of birth: Day Month Year Normal registration period until 19 th October 2018 Late fee applicable from 20 th October 02 nd November 2018 High Late applicable from 3 rd November 20 th November 2018 International GCSE Subjects Before make an entry, it is strongly recommended to refer to www.edexcel.com for more details on specification of each availa ble options Page 1 of 5
Subject Name Subject / Unit Name Unit Code Edexcel Pricing (Standard) Edexcel Pricing (Low late fee) Edexcel Pricing (High late fee) ACCOUNTING Paper 1 4AC0 600.00 1,200.00 1,800.00 ARABIC AS A FIRST LANG. Paper 1 & 2 4AR0 930.00 1,530.00 2,130.00 COMMERCE Paper 1 4CM0 600.00 1,200.00 1,800.00 FURTHER PURE MATHEMATICS Paper 1 & 2 4PM0 930.00 1,530.00 2,130.00 HUMAN BIOLOGY Paper 1 & 2 4HB0 930.00 1,530.00 2,130.00 Mathematics Specification A Paper 1FR & 2FR (New) 4MA1 930.00 1,530.00 2,130.00 Mathematics Specification A Paper 1HR & 2HR (New) 4MA1 930.00 1,530.00 2,130.00 Mathematics Specification A Paper 1FR & 2FR 4MA0 930.00 1,530.00 2,130.00 Mathematics Specification A Paper 3HR & 4HR 4MA0 930.00 1,530.00 2,130.00 MATHEMATICS B. Paper 1R & 2R (New) 4MB1 930.00 1,530.00 2,130.00 MATHEMATICS B. Paper 1R & 2R 4MB0 930.00 1,530.00 2,130.00 Summary of fees: The local fees indicated below are inclusive of sterling pound exam fees payable to Pearson Edexcel Registration fee at RM100.00 per candidate (non-refundable) RM100.00 no. of subjects x RM per subject RM no. of subjects x RM per subject RM Total International GCSE exam fee payable in Ringgit to RM Page 2 of 5
Declaration 1. I make this entry according to the provisions of the published regulations which I have studied. 2. I have given all the information required truthfully and accurately to the best of my knowledge and belief. 3. I understand that I shall be allowed to sit only for those subjects and papers for which I have entered on this form. 4. I have not made an entry at any other Edexcel examination centre. 5. I agree that there will be no postponement or refund of all fees should I decide to withdraw from the examination after the close of the registration period. 6. The will take reasonable steps to provide information or advice but cannot be held liable should there be any errors that arise in the choice of units or subjects. I agree that it is ultimately my responsibility to confirm that the units or subject I entered are correct and if I want to amend the units or subjects, I will need to pay the additional fees and late charges. 7. I accept the responsibility to ascertain the starting times and date of the examination in case the official notification does not reach me on time. Special Considerations If you are a candidate with special requirements please attach with medical report written in English to this application form. Candidates must ensure the doctor's report specifies the needs of the candidate for the examination e.g. extra time, headphones for listening test etc. Signature of candidate: Date: Signature of legal guardian: ( for the under-18 s) Disclaimer The and the Examining Boards take all reasonable steps to provide continuity of service. We feel sure you will understand, however, that we cannot be held responsible for any interruptions caused by circumstances beyond our control. If examinations or their results are disrupted, cancelled or delayed, every effort will be made to resume normal service as soon as possible. The s liability will be limited to the refund of the registration fee or re-testing at a later date. For official use only Amount paid Date of payment Receipt Number Registered by: Your completed entry form must be accompanied by the following (please tick): A recent coloured passport size photograph affixed to the entry form A copy of your passport (Non-ns) or Identity Card (ns) A copy of your previous statement of results if you have taken the Pearson Edexcel International GCSE Examination before The total examination fee Page 3 of 5
Payment Details [payable to ] Kuala Lumpur and Penang centres: Payment can be made in cash, by cheque, bank draft, bank transfer, or credit card. Kuala Lumpur and Penang bank details: Bank: Citibank Bank swift code: CITIMYKL Account Number: 0-115889-028 [Cash deposit must be made through the Citibank counter and not via the cash machine (ATM machine). If you wish to pay by cheque deposit, you may drop the cheque into the corporate box at Citibank]. Note: For payment made by bank transfer, cash or cheque deposits please call the relevant test centre to obtain a reference code first. You may hand or post the completed entry form to either of our offices which you are registering to sit the examination as shown below: Ground Floor, West Block Wisma Selangor Dredging 142C Jalan Ampang 50450 Kuala Lumpur Tel. No.: 03 2723 7900 Fax No.: 03 2713 6599 E-mail: kualalumpur.exams@britishcouncil.org.my Opening times: Mondays to Fridays Saturdays & Sundays 9.00am to 7.30pm 9.00am to 5.00pm Penang Centre Wisma Great Eastern Suite 3A.1 & 3A.2 25 Light Street 10200 Penang Tel. No.: 04 263 0330 Fax No.: 04 263 3262 E-mail: penang.exams@britishcouncil.org.my Opening times: Tuesdays to Sundays www.britishcouncil.my www.edexcel.com 9.00 am to 5.45 pm Page 4 of 5
Dear Parents/Guardians, Child Safe Collection Policy takes the safety of your child seriously. Our current Child Safe Collection Policy states that: Children aged up to 10 years are not permitted to leave the premises alone. Teenagers aged 11 17 years should only be permitted to leave the premises alone if parental consent to this has been given in writing. [Kindly complete and return the Consent Form below]. Otherwise, they must be collected by the parent or by a person for whom the parent has provided written authorisation. [Kindly contact us for alternate arrangement on a case-by-case basis.] Thank you. Yours truly, Examination Services Consent Form I, (NRIC/Passport number: ), the parent/legal guardian of candidate hereby consent to my child/charge leaving the premises on his/her own after the examination. Yours truly, Name: Date: Page 5 of 5