The Government of the Republic of Trinidad and Tobago

MINISTRY OF EDUCATION
18 Alexandra Street, St. Clair, Port of Spain, Trinidad and Tobago

Caribbean Examinations Council (CXC)

CARIBBEAN SECONDARY EDUCATION CERTIFICATE (CSEC)
PRIVATE CANDIDATES
JANUARY 2017
NATIONAL
Before completing this form, please read the accompanying instructions carefully. This registration form
should be completed in BLOCK LETTERS and taken to the selected registration venue (see schedule in
instruction sheet) from 17th to 29th August 2016. Incomplete registration forms will not be
accepted.
SECTION A GENERAL INFORMATION
For NEW Candidates, the name written on the entry form must be the same as indicated on the
Birth Certificate. ALL other Candidates must supply the name(s) that appeared on past CSEC
certificates or preliminary result slips.
See Instructions, Section A
First Name:
Other Name:
Surname:

Sex:

Male

Femal
e

/
Date of Birth

(DD/MM/YYYY)
Birth Certificate PIN
Number:

Birth Certificate PIN Number

Mailing Address:
Street Name
Town/City
Telephone Numbers:
Mobile
Email Address:

Home

Please provide one (1) form of valid photo identification (i.e. Identification that has not expired)
This ID should be the same provided during the examination.

Identification Card
Number:
Drivers Permit
Number:
Passport Number:

SECTION B PREFERRED CENTRE LOCATION

See Instructions, Section B
Preferred Centre Location:
SECTION C LISTING OF SUBJECTS
Please list below, the name(s) of the subject(s) which you intend to sit, and indicate by a tick
() under the Repeat, Resit, Alternate and Self-Tutored columns as appropriate.
See Instructions, Section C
NB: If the Resit and Alternate boxes for a subject are left blank, you will automatically registered as
Alternate.

No
.
1
2
3
4
5

Subjects

Repeat

Resit

Alternate

SelfTutored

NB:- If any Resit box is ticked: Enter your May/June 2016 CSEC Registration Number here:
SECTION D FEES
PREVIOUSLY
REGISTERED PRIVATE
CANDIDATES FROM
JANUARY 2010
YES

NO
If YES:
JANUAR
Y

FEE
Candidate
Administrative
Subject

YEA
JUNE
Spanish Orals
R
201
0
201
Late Entry
1
201
2
201
3
201
4
201
5
201
6
SECTION E DECLARATION

AMOUN
T
$
118.00
8.00
120.00
3.00

NUMBER OF
SUBJECTS

TOTAL

x
x

=
=

SubTotal
162.00

Total

DECLARATION OF CANDIDATE
I, .......................................................................................................................................................................
............................................
(Complete
in
BLOCK
LETTERS)
First
Name
Surname
declare that I make this entry in accordance with the issued instructions which I have read and understood
and that 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 the subject(s) indicated on this form. I further understand
that my application will not be considered if incorrect information is supplied. Candidates MUST check
ONLINE for the accuracy of their registration during the period 17 th to 21st October 2016, using the website
ors.cxc.org/studentportal. You will be required to enter your Birth Certificate PIN Number, Surname,
Date of Birth and Select 2017 JANUARY CSEC.

Any inaccuracies must be reported by 25th October 2016 to the Supervisor of Examinations, Ministry of
Education, #18 Alexandra Street, St. Clair, Port of Spain.
..............

Date:

..............

yyyy

..........................
...............
Receipt Number
dd

.....................................................................................................
..............

mm

Signature of Candidate
dd
FOR OFFICIAL USE ONLY

...............

...............

yyyy

mm

Checked
by: .............................................................
Ministry of Educations
...
Stamp
Signature & Name in
BLOCK LETTERS
LIST OF TTPOST OUTLETS WHERE COURIER STICKERS CAN BE PURCHASED
DO NOT WRITE YOUR NAME OR SIGN ON THE STICKER
DO NOT PEEL OFF ANY STICKER AND AFFIX TO ENVELOPES

AREA

ADDRESS

North West

Port of Spain Business Centre, #92A Wrightson Road,

Port of Spain
#22 Abercromby Street, Port of Spain
#61-63 Western Main Road, St. James
#29 St. Anns Main Road, St. Anns
Belmont Circular Road, Belmont
#546 Western Main Road, Carenage
National Mail Centre, #240-250 Golden Grove Road,
Piarco
Eastern Main Road, Tunapuna
#5 Eastern Main Road, San Juan
TTPOST Arima,
17 Prince Street, Arima
#9 St. Yves Street, Chaguanas
Corner Bryce & La Croix Street, Couva
CLICO Building, #1 Oropuche Road, Siparia
#2 Lucky Street, La Romain
#5 Seecharan Street, New Grant
Teal Building, Milford Road, Scarborough
Milford Court, Milford Road, Bon Accord

North East

Central
South
Tobago
Envelope 1

Envelope 2
$2.00

Name: ..................................Stam
p
Address: ...............................
..............................................
..............................................

$2.00

Name: ..................................Stam
p
Address: ...............................
..............................................
..............................................

Envelope 3

Envelope 4 (if doing

Spanish)

Name: ..................................
Address: ...............................
..............................................
..............................................
Contact Number: .................

$2.00
Stam
p

Name: ..................................
Address: ...............................
..............................................
..............................................

PLEASE NOTE: No stamp is placed on Envelope 3, which is to be used for the

mailing of the certificate by registered mail.
At registration, the Officer will affix the appropriate sticker to both
copies of application forms and the envelope for the certificate.