PEARSON EDEXCEL INTERNATIONAL GCSE EXAMINATIONS (IGCSE) JANUARY 2015 PHOTO Affix your most recent passport size photo here (write your name at the back of the photo) Centre Name FOR OFFICIAL USE ONLY 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) Centre Number 94595 P B Candidate Number Full Name (in BLOCK letters as per Identity Document): 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 st th Normal registration period 1 October 2014 to 20 October 2014 st th Late registration period 21 October 2014 to 24 November 2014 International GCSE Subjects Before make an entry, it is strongly recommended to refer to www.edexcel.com for more details on specification of each available options Paper Title Unit code (circle the required code you wish to register for) Papers Option Code (circle the required code you wish to register for) Fee per syllabus (RM) Accounting 4AC0 Paper 1 RM740.00 Arabic (First Language) 4AR0 Paper 1 & 2 RM740.00 Bengali 4BE0 Paper 1 RM740.00 Biology 4B10 (R) Paper 1 & 2 RM740.00 Chemistry 4CM0 Paper 1 & 2 RM740.00 Commerce 4CM0 Paper 1 RM740.00 Economics 4EC0 Paper 1 RM740.00 4EA0 Paper 1 & 2 Paper 1, Coursework 3 & Coursework 4 marks transferred from previous series English Language Specification A A RM740.00 BT RM740.00 Page 1 of 3 Paper Title English Language Specification B Unit code (circle the required code you wish to register for) 4EB0 Papers Option Code (circle the required code you wish to register for) Paper 1 RM740.00 Paper 1 & 2 English Literature 4ET0 Fee per subject (RM) Paper 1, Coursework 3 marks transferred from previous series A RM740.00 BT RM740.00 Further Pure Mathematics 4PM0 Paper 1 & 2 RM740.00 Human Biology 4HB0 Paper 1 & 2 RM740.00 Mathematics Specification A 4MA0 Paper 1F & 2F F RM740.00 Paper 3H & 4H H RM740.00 Mathematics Specification B 4MB0 Paper 1 & 2 RM740.00 Physics 4PH0 Paper 1 & 2 RM740.00 Science Double Award 4SC0 Biology Paper 1 Chemistry Paper 1 Physic Paper 1 RM900.00 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 RM740.00.00 per subject RM ______ no. of subjects x RM900.00.00 per subject RM st th Late entry fees (Late registration period 21 October 2014 to 24 November 2014) Registration fee at RM100.00 per candidate (non-refundable) + ______ no. of International GCSE subjects x RM290.00 per subject RM 100.00 RM Total International GCSE exam fee payable in Ringgit Malaysia to “British Council” RM Declaration 1. 2. 3. 4. 5. 6. 7. I make this entry according to the provisions of the published regulations which I have studied. I have given all the information required truthfully and accurately to the best of my knowledge and belief. I understand that I shall be allowed to sit only for those subjects and papers for which I have entered on this form. I have not made an entry at any other Edexcel examination centre. 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. The British Council 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. 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. Page 2 of 3 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: ________________________ Disclaimer The British Council 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 British Council’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-Malaysians) or Identity Card (Malaysians) A copy of your previous statement of results if you have taken the Pearson Edexcel International GCSE Examination before The total examination fee Payment Details [payable to “British Council”] 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]. 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: British Council 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 for enquiries only: [email protected] Registration times: Mondays to Fridays Saturdays & Sundays 9.00am to 4.30pm 9.00am to 4.30pm British Council 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: [email protected] Opening times: Tuesdays to Sundays 9.00am to 5.00pm www.britishcouncil.my www.edexcel.com Page 3 of 3