CONFIRMATION FORM

Information of candidate

Candidate’s name

Date of birth

Test date

Test module

Receipt number (if applicable)

I notice that there are some slight differences or changes on my name or ID document against information on
my IELTS application form. I want to make some amendments as below (tick as appropriate):

o Name of candidate

Correct Family name:

Correct Middle and Given name:

(must appear in the same order as on ID document)

o ID document (which will be used for my IELTS test)

ID type (Passport or CMND):

ID number:

Photocopy of ID document (Yes or No):

o Other (please specify)

I hereby confirm that the information above is authentic and I may be disqualified from an IELTS test if any are
discrepancies found during the test.

Signature of candidate Date (DD/MM/YY)

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