Exam date:_________________________

Purpose:___________________________
TELC EXAMS
ANMELDUNGSFORMULAR / EXAM REGISTRATION FORM
I am paying the test fee _______________
Requirements: (amount) in/via:
Completely-filled out registration form
One photocopy of valid passport or NBI clearance or SSS UMID o Cash
o Check (payable to Euro Language Center)
(The original has to be presented on the exam day and proof of o Door-to-door Money transfer
Full payment of the exam fee)

I would like to take the exam: Alna P. Lechner (receiver)

Euro Language Center
o telc Deutsch B1 Room 305, LDM Bldg., Legaspi St.,
o telc Deutsch B2 Cebu City
o telc Deutsch Pflege B1/B2 Mobile Number: 09175623300

o Bank Deposit (in Peso)

Declaration of Consent:
Bank: BPI-Ayala Cebu
o I certify that I have read and understood the Account Name: Alna P. Lechner
examination guidelines. Account Number: 1356-1269-07
o I am aware that I should be at the Center ---------------------------------------------------------------
at least 30 minutes before the scheduled examination time. o Herr Mr. o Frau Ms.
o I understand that Euro Language Center has duly
informed me of the exact date and time upon registration exam, I may(wie
Nachname view immy test ____________________
Pass): paper (upon a request in writing subject to
and will not issue any further reminder, unless Euro Telc name
Last Germany approval)
(as shown only in the presence of the Exam Coordinator.
in passport)
Language Center changed the schedule for a valid reason. o I understand that my failure to provide accurate and complete
o I understand that I am required to present my passport or Vorname (wie
information in im
thisPass):______________________
form may cause my application to be rejected.
NBI clearance or SSS UMID as proof of identification on the First name (as shown in passport)
exam day and upon claiming of my test results or certificate.
Adresse:___________________________
o An exam date can be changed up to four weeks before the
Address
exam. Each booking change is subject to 10% surcharge. I
understand that I will be charged the full test fee if I cancel
Land:______________________________
my test.
Country
o I understand that I will not be allowed to take the exam if I
come late.
Telefonnummer/Handynummer(mit Vorwahl):
o I understand that if any other person attempts to Telephone/Mobile number (with area code)
take the examination in my place, both I and such person
will be expelled from the exam and be prosecuted. Email:____________________________________
o I understand my results will be available at least four (4)
weeks after the test day. Geburtsland: _____________________________
o I understand that the test results will be released only to the Country of birth
examinee.
o I understand that all test papers remain the property of the Geburtsort (wie im Pass): ___________________
testing center and under no circumstances will be released to Place of birth (as shown in passport)
candidates or institutions/organizations.
o I understand that if I fail the exam, I may request for re- Staatsangehörigkeit:_______________________
checking (upon a request in writing subject to Telc Germany Citizenship
approval) within 6 weeks after results are released.
o I understand that my failure to provide accurate and Geburtsdatum:___________________________
complete information in this form may cause my application Date of birth
to be rejected. (TT-MMM-JJJJ DD-MMM-YYYY)
o I certify that the information on this form is complete, true
and accurate. Muttersprache:___________________________
Native language/mother tongue

Beruf:___________________________________
Signature/Date:_____________________________________
Occupation