Cambridge O Level Registration

Form OCT/NOV 2023 Exams

Candidate’s detail
:Admission Number Paste a Postal ID Size Photo here.
Attach two others with paper clips
Full Name
DAKSHITH ASHANE SEAN DWIGHT
with Initials
(As to be Printed on Certificate )
(D.A.S DWIGHT)

ID Number
N6961659 16 10 2008
(PP/Postal ) MM YYYY
DD
Date Of Birth
Male/ Female
Gender:
MALE 14+
Age: ___________________

Home Address: 7A/39, TEMPLERS SQUARE, DE SOYSA MAWATHA, MOUNT LAVINIA

Details of Parent/Guardian

Name SEAN DWIGHT

Tel No Mobile 0777 557264

Land line: 011 2634716

Email office sean.dwight@cinnamonair.com

Email Personal pushdwight@gmail.com

KEY DATES

Registration Type Start End Late fee (LKR)

Normal registration period: 17 July 2023 09 August 2023 N/A

Normal fee +
Late Stage 1 registration period: 10 August 2023 02 September 2023 22,160.00 per
subject
Very Late stage 2 Fee applies for late entry
amendments informed to us from 03
September 2023 onwards. Normal fee +
Late Stage 2 registration period: 54,580.00 per
These will be processed as off system subject
entries following the approval from the exam
board (Refer the information sheet)
PLEASE REFER TO THE SUBJECT CODES BOOKLET BEFORE COMPLETING THE BELOW SECTION

Subject Option
Subject Name Signature
Code Code
Additional Mathematics 4037 AY
Computer science 2210 AY
English Language 1123 Y
Mathematics sylllabus D 4024 Y
Physics 5054 BY
Art 0400 A

Declaration by Candidate
• I make this entry according to the provisions of the published regulations which I have read.
• I understand that if I take a Cambridge International Examination Assessment, you will pass information
about me to Cambridge Assessment International Examinations, who will use the information I have
provided to process the exam entries and results or for other examination-related activities such as
standard setting,maintaining the integrity of the assessments or to identify plagiarism,and for record
keeping purposes.
• 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 for those subjects and papers for which I have entered on
this form
• I have not made an entry at any other Cambridge International centers.
• I have informed the examination center in advance the special arrangements I would require on the
examination day (If required) and my medical concerns.

Signature of Candidate Date Signature of Parent / Guardian Date

Declaration by Class Teacher

For the purpose of preventing impersonation in the examination I have examined documentary evidence
of the above candidate and am satisfied as to the true identity of the candidate taking this examination.

Important
> Submit the Paid Bank Deposit Slip
> Other modes of payment
(Online Transfer / ATM Deposit) are not accepted.
> Please cross - check "Total payable " with the
examination officer before paying.
> Clearly State the following on the bank slip when you
make the payments.

o Candidate's name with initials

o Exam Batch: Example. O level Oct/Nov 23

*Please keep a copy of the application form for your own reference