18 Alexandra Street, St. Clair, Port of Spain.

Trindad and Tobago

Caribbean Examinations Council (CXC)

CARIBBEAN SECONDARY EDUCATION CERTIFICATE (CSEC)

PRIVATE CANDIDATES

JANUARY 2015

NATIONAL

Before completing this form, please read the accompanying instructions carefully. This registration form should be
completed in BLOCK LETTERS and returned to the selected registration venue (see schedule in instruction sheet) between
the 14th August to 26th August, 2014. Incomplete registration forms will not be accepted.
SECTION A - GENERAL INFORMATION
For NEW Candidates the name written on the entry form must be the same as indicated on the birth certificate. ALL
other Candidates must supply the name(s) that appeared on past CSEC certificates or preliminary results slip.
See Instructions,Section A
First Name

Place Photograph here

Other Name
Surname
Sex:

Male

Female
Date of Birth(DD MM YYYY)

Birth Cert. No.

Please print name at the

back of a recent
photograph of yourself
and staple in the
space provided

Birth Certificate pin number

Mailing Address
Street Name

Town/city

Telephone No.

Home

Mobile

Email Address
Please provide one (1) form of valid photo identification. (ie. Identification that has not expired)
This ID should be the same provided during the examination.

Identification Card No.

Driver's Permit No.
Passport No.

SECTION B - PREFERRED CENTRE LOCATION

See instructions, Section B

Preferred Centre
Location
SECTION C - LISTING OF SUBJECTS

Please list below, the name(s) of the subject(s) which you intend to sit, and indicate by a tick ( ), under
the Repeat, Resit, Alternate, and Self-Tutored Columns, as appropriate.
See Instructions, Section C
NB: If the Resit and Alternate boxes for a subject are left blank, you will be automatically registered as 'Alternate'

No.
Subjects
Repeat Resit
Alternate
1
2
3
4
5
NB:-If any Resit box is ticked: Enter your May/June 2014 CSEC Reg. No. here:SECTION D - FEES
PREVIOUSLY REGISTERED
PRIVATE CANDIDATES FROM
JAN 2010
YES
NO
If YES:
YEAR
JAN
JUN
2010
2011
2012
2013
2014
SECTION E- DECLARATION

AMOUNT
NO. of SUBJECTS
$
118.00

8.00

120.00 X
3.00 X
Sub-Total

162.00

FEE
Candidate
Administrative
Subject
Spanish Orals
Late Entry

Total

Self-tutored

TOTAL

DECLARATION OF CANDIDATE
I, .
(Complete in BLOCK LETTERS)
First Name
Surname
declare that I make this entry in accordance with the issued instructions which I have read and understood, and that I have given all the
information required truthfully and accurately to the best of my knowledge. I understand that I shall be allowed to sit only those
subject(s) as indicated on this form. I further understand that my application will not be considered if incorrect information is supplied.
Candidates MUST check ONLINE for the accuracy of their registration during the period 17th to 21st November, 2014 using the website
ors.cxc.org/studentportal. You may need to enter your:- Date of Birth and Pin No., Centre No., Candidate No. and Last Name. Any
inaccuracies must be reported immediately to the Supervisor of Examinations, Ministry of Education, Examinations Section, # 18
Alexandra Street, Port of Spain.

..
Signature of Candidate

..
yyyy

FOR OFFICIAL USE ONLY

Receipt No

.. . .
yyyy
mm
dd

Checked
by
..

SIGNATURE

Name in BLOCK LETTERS Ministry of Education Stamp

.
mm
Date

..
dd