ACCA Diploma in Accounting and Business
Registration Form – June 2013 Examinations
Firstname:__________________________________Surname:_______________________________
Address:___________________________________________________________________________
___________________________________________________________________________
ACCA Registration Number:_____________________Date of Birth: _____/_____/________________
Home Phone:______________________________Mobile Phone:_____________________________
Email:_____________________________________________________________________________
Please tick subject or subjects for which you are registering:
Subject
Financial Accounting (FFA)
Management Accounting (FMA)
Accountant in Business (FAB)
€500 
€500 
€500 
Payment method: (Cheques payable to Independent College Dublin)
 Cheque
 Bank Draft
 Postal Order
 Credit/Debit Card/Laser
If you wish to pay by credit card or laser, please fill in page 2 and submit with your application form.
(Details will be shredded after payment is processed.)
Declaration
I hereby confirm that all particulars given in this application are true and correct, and understand that I must take
responsibility to register myself with ACCA. I also understand that course commencement will depend on student
demand and that fees will not be refunded once the course commences. I also grant permission to Independent
Colleges to release my name and ACCA Registration number to ACCA to obtain statistics.
Signature:________________________________________________ Date:_________________
Please send your completed application form to Independent Colleges, 60–63
Dawson Street, Dublin 2. Telephone +353 1 672 5058
Email: [email protected]
FORENAME
SURNAME
COURSE
AMOUNT PAYABLE
€
PAYMENT
Visa
Mastercard
Laser
Amount to Debit:
Credit Card Number:
Laser Card Number:
CVV:
Expiry Date:
Cardholders Name:
COMMENTS
Please send your completed application form to Independent Colleges, 60–63
Dawson Street, Dublin 2. Telephone +353 1 672 5058
Email: [email protected]