PLANET EDUPRO INDONESIA

TEL : 021-70756643, 6315986 FAX: 021-6330553 EMAIL planetedupro@centrin.net.id

ESOL EXAMINATIONS
CANDIDATE REGISTRATION FORM

SOP Code

Form 7Ca

Page

1 of 1

Issue Date

24/10/2016

Edition / Revision

1/0

Control

General Manager
Exams Ops Outgoing

Status

This form may be returned by post or by electronic mail to planetedupro@centrin.net.id (*please scan for virus before
email transfer)
Please choose ONE EXAMINATION of your choice and fill in the date of your choice. Please fax your transfer slip to
021-6330553.

YOUNG LEARNERS ENGLISH

GENERAL ENGLISH MAINSUITE
BUSINESS ENGLISH CERTIFICATE
TEACHING KNOWLEDGE TEST
BUSINESS LANGUAGE TESTING SERVICES

EXAM DATE

Starters Movers Flyers

KET PET FCE CAE CPE
BEC (P) BEC (V) BEC (H)
Module 1 Module 2 Module 3
Computer Standard
TOTAL EXAMINATION FEE DUE

CANDIDATE NAME

PLACE OF
BIRTH

(CAPITAL LETTERS)

Address

(Capital Letters):

DATE OF BIRTH
TEL (home)

Photo (2 x 3)

TEL (hp)
TEL (office)
EMAIL

Candidate Signature

GENDER

F/M

ID Number
(Please
provide
clear
photocopy of your ID Card)

CANDIDATES PARENTS / GUARDIAN CONSENT FORM

Signature

Name
Tel / HP
Address

Examination fees are payable by CASH or BANK TRANSFER by the payment deadline through:
Bank Central Asia (BCA) KCP Harmoni
Ruko Harmoni Plaza B25, Jalan Suryopranoto No 2, Jakarta 10130
Account No 6530305277 in favour of PLANET EDUPRO INDONESIA
OFFICE USE ONLY (DO NOT FILL IN)
Date Received
Remarks

Exam Officer Signature