Please read the information below before completing this form
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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
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 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
• 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.
Example: = 1 @ £36.00 = 4 @ £10.00 = £46.00 Please complete the following for each series being requested:
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.
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
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
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
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