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Certifying Statement Application

Results and certificates – Form 7


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

Form 9.


• 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 info@cie.org.uk. 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

Candidate information


Current full name

(including title)


Full name at the time of the exam

Date of birth

(DD/MM/YY)


Current address

(including postcode)

Postcode


Daytime telephone number

Email address



Examination details

Please provide as much information as possible to avoid delays in processing your application.
*The certifying statement costs £36.00. All additional copies of the certifying statement cost £10.00 each.

Exam series

e.g. June

2012

Qualification

e.g. Cambridge

IGCSE

Centre number

Candidate number

Centre name and address

Total number of copies required*


JUNE 2012


IGCSE


ZZ123


123456

The Cambridge

School

1 Cambridge Road, Cambridge, UK


5



Example:

= 1 @ £36.00
= 4 @ £10.00
= £46.00

Please complete the following for each series being requested:


Exam

series

e.g. June

2012


Qualification

e.g. Cambridge IGCSE



Centre

number

Candidate

number

Centre name and

address

Total number

of copies required*




























































































We do not issue certifying statements for UNGRADED, NO RESULT, PENDING or TO BE ISSUED outcomes.

Delivery details
Please provide a contact name, postal address and telephone number for each recipient of the certifying

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.


ADDRESS ONE
Name and job title of person receiving certifying statement
Postal address of person receiving certifying statement

Postcode


Delivery method – please tick

See payment page for fees

UPS Special Delivery Airmail




ADDRESS TWO (if relevant)
Name and job title of person receiving certifying statement
Postal address of person receiving certifying statement

Postcode


Delivery method – please tick

See payment page for fees

UPS Special Delivery Airmail




ADDRESS THREE (if relevant)
Name and job title of person receiving certifying statement
Postal address of person receiving certifying statement

Postcode


Delivery method – please tick

See payment page for fees

UPS Special Delivery Airmail



If copies are to be sent to more than three addresses please write them on an additional sheet of paper and attach to this form.



Fees
We charge a fee for each certifying statement for each exam series to cover administration and postage. All credit card payments are subject to a 2 per cent handling fee. We do not accept electronic bank transfer or cash payments. Please work out the total amount payable and then complete the relevant payment section below.


FEES

Price

Quantity

Total

(i) Certifying statement

£36.00







(ii) For each extra copy of a statement

£10.00







Courier despatch for each overseas address (we recommend you use this service if you want a

traceable despatch method)


£32.50








Despatch by Special Delivery for each UK address

£8.00










Sub total






If you require authentication by a notary public and the Foreign and Commonwealth Office, as laid down in the Hague Agreement, please specify the quantity of statements for each series below. Please be advised that this service should not be requested for use in the United Kingdom. For further information, please visit https://www.gov.uk/government/organisations/foreign-commonwealth-office





Price

Quantity

Total

Cost of authentication per statement

£128.00










Sub total




Total fees payable





Credit or debit card

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.


Credit or debit card Cardholder name Cardholder address Fees payable

Handling fee (2 per cent for credit cards only)

Handling fee (3 per cent for American Express cards only)

Total amount payable

Credit or debit card number











£

£

£



















































CVC number (last 3 digits on reverse of card near signature) Card expiry date
Cheque, postal order, international money order

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’.


Total amount payable £ Method of payment (e.g. cheque, postal order)

Cheque/money order reference number
Invoice (for Cambridge Centres only)

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.


Total amount payable
Centre number

Signed Date





£





















(DD/MM/YY)
Name in full
For internal use only Reference number Country code


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