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Results enquiry payment form

Please fill in the following details:

Visa

MasterCa
rd

Debit Card

Card No.

CVC No. (Last 3 digits on


reverse of card)

Expiry Date:

Issue Number (Debit


card) ID Number
Payment value

32

GBP
EURO
Please confirm currency

Item

BMAT Result Enquiry

Candidate Name

BENIAMIN VASILENIUC

US$

Signed:
Cardholders Full Name
(Please print full name in
BLOCK CAPITALS)

UNGUREAN MARIA MIRELA

Date (dd/mm/yy)

1 1

Return to:
The Revenue Section, Finance, Cambridge English Language Assessment 1 Regent
St, Cambridge, CB2 1GG, United Kingdom
Telephone: +44 (0)1223 558644/558643
Fax: +44 (0)1223 558930
Finance Only:
12100 ED32
0
0

Z104
2

Results Enquiry Unit


DDunderdale8336/ARivers3813

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