←Please staple the postal money order here (Do Not Paste!

) ─

Please print the postal money order number

Fee for Application

Area Normal (NT/Piece) Rush order (NT/Piece)
Score America、Canada Europe、Africa 300+110=410 600+110=710
Report Asia、Oceania 300+100=400 600+100=700
Note:
1.The price includes Score Report fee or Certificate and mailing fee
2.Method of Payment：A. Cash ※Only available at the front desk of Chun Shin Limited
B. Postal money order 【Recipient： ：忠欣股份有限公司】
忠欣股份有限公司】
3.Please enclose the completed form along with the postal money order and send via registered mail to
「TOEIC Speaking & Writing Testing Center 」(106) P.O.Box 26-585 TAIPEI, TAIWAN
4.If you have any further information, please contact TOEIC Test Testing Department by phone: (02) 2701-7333

Examinee Information
Name:
Citizen ID or Passport #:
Date of Birth:
Contact Telephone #:
Test Date:
Admission Ticket Number:
(We will mail your receipt to you)
Address in Taiwan:
(Please write in Chinese)

Organization / Institution information

Name of organization/institution:

Contact Person:
Contact Number:
Mailing information
Recipient:

Address:

Zip code:

Country:

I, ___________________, give my permission for ETS Taiwan Representative, Chun Shin

Limited, to release my TOEIC Speaking & Writing Test score on ______/______/______ (date)
to _________________________ (name of organization/institution). I understand the purpose for which
this organization/institution will use my TOEIC Speaking & Writing Test score.

Signature of examinee:

Date: