CAMBRIDGE INTERNATIONAL EXAMINATIONS ENTRY FORM
SERI STAMFORD COLLEGE
(CENTRE NUMBER: MY022)
I hereby apply for entry to the above mentioned examination to be held on:
Month: Oct/Nov (A2 orA Level) Year: 2017
Full name as in I/C or Passport
Address: ______
Email Address: ______Gender: Male Female
Telephone: ______
Date of birth: Intake: July 2016 / Private Candidate
I/C or Passport No: ______
Previous Centre / Exam No: ______/______
I confirm that the above information given by me is true. I understand that Seri Stamford College has the right to withdraw my entry should any discrepancy be found.
Signature of candidate: ______
Name of candidate : ______
Date : ______
Due date to submit form & payment: 11thAugust 2017 (Friday) by 4.00pm
Please attach the previous exam statement of results
Subject / Code / Level / Components / Option Code / Tick ( ) / StatusBiology / 9700 / A2 only / 43, 53,85, 88 / BU / A2 / A Level
A2 only / 43, 53, 96, 99 / CZ
A Level / 13, 23, 35, 43, 53 / AZ
A Level / 13, 23, 35, 43, 53, 85, 88, 96, 99 / GU
Chemistry / 9701 / A2 only / 43, 53, 85, 88 / BU
A2 only / 43, 53, 96, 99 / CZ
A Level / 13, 23, 35, 43, 53 / AZ
A Level / 13, 23, 35, 43, 53, 85, 88, 96, 99 / GU
Physics / 9702 / A2 only / 43, 53, 85, 88 / BU
A2 only / 43, 53, 96, 99 / CZ
A Level / 13, 23, 35, 43, 53 / AZ
A Level / 13, 23, 35, 43, 53, 85, 88, 96, 99 / GU
Accounting / 9706 / A2 only / 32, 89 / BR
A2 only / 32, 98 / CY
A Level / 12, 22, 32 / AY
A Level / 12, 22, 32, 89, 98 / GR
Business / 9609 / A2 only / 32, 89 / BR
A2 only / 32, 98 / CY
A Level / 12, 22, 32 / AY
A Level / 12, 22, 32, 89, 98 / GR
Economics / 9708 / A2 only / 32, 42, 88 / BY
A2 only / 32, 42, 98 / CY
A Level / 12, 22, 32, 42 / AY
A Level / 12, 22, 32, 42, 88, 98 / DY
Law / 9084 / A2 only / 32, 42, 89 / BR
A2 only / 32, 42, 98 / CY
A Level / 12, 22, 32, 42 / AY
A Level / 12, 22, 32, 42, 89, 98 / GR
Mathematics / 9709 / A2 only / Kindly refer to the attachment
A Level / Kindly refer to the attachment
Note :
Component Code 85 – June AS Mark (12,22,33) Carried Forward
Component Code 88 – June AS Mark (12,22,34) Carried Forward for 9700, 9701 & 9702
Component Code 88 – June AS Mark (12,22) Carried Forward for 9708
Component Code 89 – June AS Mark (13,23) Carried Forward
Component Code 96 – November AS Mark (13,23,35) Carried Forward
Component Code 98 – November AS Mark (12,22) Carried Forward
Component Code 99 – November AS Mark (13,23,36) Carried Forward
I confirm that the above is correct.
………………………………….. ….………….…………………
Candidate’s Name Candidate's Signature
Description / Fee / Qty / Amount [RM]Basic Entry / 265.00 / 1 / 265.00
Private Candidate / 800.00
Late Entry (After 11 August 2017) / 260.00
Very Late Entry (After 1 Sept. 2017) / 560.00
A2 only
‘A2’ Level per Subject / 350.00
A Level (AS + A2)
‘A Level’ per Subject / 500.00
*Practical Fee per Subject / 215.00
Total / RM
* Applicable to Biology, Chemistry and Physics
Examination fees are to be paid to cashiers only. All payments must be made by crossed cheque, money order or bank draft made payable to SERI STAMFORD COLLEGE SDN BHD.Please keep the receipt of payment made as proof of payment.
Seri Stamford College Sdn. Bhd. (CIMB Account No.: 8002325364)
Examination fees are non- refundable and non- transferable where no acceptable proof of medical grounds can be provided.
Entry checked and confirmed by Examination Department Officer:
______Signature: ______
Date: ______
Cashier's Name: ______Date : ______
Signature : ______Official Receipt No: ______
Amount collected: ______
Mathematics (9709)
Option Code / Components CodeAZ / 13, 33, 43, 63
BZ / 13, 33, 43, 53
CZ / 13, 33, 63, 73
DZ / 33, 63, 86
EZ / 33, 43, 89
FZ / 33, 53, 86
GZ / 33, 73, 89
HZ / 33, 63, 96
IZ / 33, 43, 99
JZ / 33, 53, 96
KZ / 33, 73, 99
LZ / 13, 33, 43, 63, 86, 89, 96, 99
MZ / 13, 33, 43, 53, 86, 96
NZ / 13, 33, 63, 73, 89, 99
Components Code / Component title
86 / June Mechanics AS Mark (13, 43) Carried Forward
89 / June Statistics AS Mark (13, 63) Carried Forward
96 / November Mechanics AS Mark (13, 43) Carried Forward
99 / November Statistics AS Mark (13, 63) Carried Forward
Page 1 of 4