PLEASE READ THE INFORMATION BELOW BEFORE COMPLETING THIS FORM
• This form is valid for applications made from October 2013 to the end of September 2014. It is for Cambridge candidates who require an official document from Cambridge to show the grades they achieved in a particular exam series.
• This form is also used when a Cambridge candidate needs a notary public to authenticate their results. For security reasons we cannot confirm your results over the telephone or by fax.
• Applications are processed in order of receipt within a 28 day time-frame.
• You can only apply for a certifying statement once you have received your certificate. This form must not
be used to request results from the current examination series – please use the Priority Results service via
• Candidate identification must be in English and clearly show the candidate’s name and date of birth.
• We produce certifying statements using the name given for the candidate at the time of their exam. We will consider requests for minor amendments if:
The request is made clearly in an accompanying letter or email
The request is being made within 18 months of receipt of the original certificate
The amendment can be verified against the candidate’s identification
Completing the form
Fill out the form in BLOCK CAPITAL letters using black ink. Check you have completed the following steps:
- You have correctly calculated the fee required
- You have submitted a photocopy of relevant identification which shows your name and date of birth in English.
Acceptable forms of identification are:
• A photocopy of your birth certificate
• A photocopy of the appropriate pages of your passport
• A photocopy of your driving licence
- You have completed the relevant payment section at the end of the form
- You have enclosed payment for the correct amount using one of the payment methods detailed on the form.
Returning the form
The method you must use to return the form depends on the way you decide to pay the required fee.
Credit card or debit card
• If you pay by credit or debit card do not return this form by email, as we cannot guarantee the security of your card details.
• You must return the form by post or fax.
o By post: Certifying Statement Administrator, Exam Data Management, Operations, Cambridge International Examinations, Cambridge Assessment DC10, Hill Farm Road, Whittlesford, Cambridge, CB22 4FZ, United Kingdom.
o By secure fax: +44 1223 558930
Cheque, postal order, international money order or invoice
• If you pay by cheque, postal order or international money order you must return the form by post.
• If they are still registered with us, the examination Centre where you sat your exam(s) can submit the application on your behalf and we will invoice them for the payment.
• If paying on receipt of an invoice, examination Centres can return the form by post, fax or email.
o By post and fax: use the details above.
o By email: return to firstname.lastname@example.org. Add: ‘Certifying Statement Application’ in the subject field.
If a result cannot be found we will refund the delivery fee paid and any cost of copies requested.
Please make sure that your exams were conducted by Cambridge International Examinations. If you sat your examinations through either of our sister examinations boards, please contact them directly viawww.cambridgeenglish.org or www.ocr.org.uk
statement. If you require that any additional information is added to the address label (such as University reference number) please inform us on a separate piece of paper.
Complete all the fields below. Enter the total fees, calculate and enter the handling fee if paying by credit card/American Express, and then enter the total amount payable.
You can pay by cheque, postal order or international money order for the correct amount in pounds sterling drawn on a British bank. These must be crossed and made payable to ‘University of Cambridge Local Examinations Syndicate’.
If they are still registered with us, the Centre where the candidate sat the exam(s) can submit the application on the candidate’s behalf and we will invoice them for the payment.