Registration Form

for DELF/DALF
Examinations Photo
(35 × 45 mm)

FILL IN THE FORM USING BLACK OR BLUE BALLPOINT PEN. USE CAPITAL LETTERS AND TICK WHERE APPLICABLE.

Centre: ALLIANCE FRANÇAISE DE DHAKA City: DHAKA Country: BANGLADESH

q Dhanmondi q
Gulshan Uttara qClass: AFD/Hanaf ID: 1 0

INFORMATION
Information provided here is reflected in the certificate. Any alterations later will incur a fee of BDT 1,000* per certificate. Fields in red are not alterable.

Have you registered for any DELF/DALF examinations before? qNo qYes
If yes, DELF/DALF ID: 8 8 0 0 0 - 0 0 Sex: qFemale qMale
Surname:
As it appears on your passport/NID/previous ‘Registration Form for DELF/DALF Examinations’ (if any)

Given name(s):

Age: Date of birth: / / Place of birth:

For date format, use: DD/MM/YYYY

qBangladesh qOther:
Country of birth: Mother tongue: qBangla qOther:
Nationality: qBangladeshi qOther: Second nationality:

Parent’s name:

† Dhanmondi, Gulshan and Uttara branches only

Address:

Mobile: E-mail:

The examination you are registering for:

Please note: ‘DELF Prim’ is for children aged below 12, ‘DELF Junior’ for aged 12 to 16 and ‘tout public’ for aged 16+.

Year: Session: qMarch qJune qSeptember qDecember

* depends on currency exchange rate
DELF Prim DELF qJunior/qTout public DALF Tout public
q Prim A1.1 qA1 qA2 q
q
C1 qC2
Lettres et sciences humaines
q Prim A1 Prim A2 q qB1 qB2 q Sciences

BDT BDT BDT

TERMS AND CONDITIONS

1 The non-refundable registration fee must be deposited to Commercial Bank of Ceylon PLC† (a/c: Alliance Française de Dhaka, a/c no. 1140632000) within three consecutive
working days. After depositing your payment, you are requested to submit the ‘bank deposit confirmation slip’ to the registration office.
2 In case of illness or professional incapacity on the date of the test, you will be asked to provide a medical certificate or a written statement from the employer in order to defer
your enrolment to the subsequent session. Only one postponement is possible. The registration fees cannot be reimbursed.
3 After processing the completed registration form, Alliance Française de Dhaka will provide you with a document titled attestation d'inscription which you must bring with you on
the day of the test. If you have not received your attestation d'inscription three days prior to the date of the test, you must contact the reception in person during office hours.
4 Being a national examination, the dates of oral or written tests cannot be changed.
5 You have to strictly maintain the timings mentioned in the ‘test schedule’ or convocation, failure to do so would cancel your right to take the test.
6 You can only bring pen(s) (not a pencil/highlighter marker or mobile phone or other belongings etc.) inside the test centre.

I have read and understood the terms and conditions, and I accept them. Signature:
2020-01-WEB

ADMINISTRATION: RECEIVED BDT RECEIPT NO. DATED: BY: