This document appears to be a registration form for the Caribbean Advanced Proficiency Examination (CAPE). It requests information such as contact details, identification, date of birth, subjects to be taken, preferred exam center, and fees. The candidate must sign a declaration that the information is accurate and agree to exam rules before returning the completed form by a specified deadline.

1. −
−
Email Address
Please provide one (1) form of valid photo identification. (ie. Identification that has not expired) This ID should be the same provided during the examination.
Identification Card No.
Driver's Permit No.
Passport No.
Mailing Address
Street Name
Town/city
Telephone No.
Home
Mobile
Other Name
Please print name at the back of a recent photograph of yourself and staple in the space provided
Surname Name
Sex:
Male
Female
Date of Birth(DD MM YYYY)
Birth Cert. No.
Before completing this form, please read the accompanying instructions carefully. This registration form should be completed in BLOCK LETTERS and returned to the selected registration venue (see schedule in instruction sheet) between the period 22nd September to 3rd October, 2014. 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 CAPE certificates or preliminary results slip.
See Instructions,Section A
First Name
Place Photograph here
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 ADVANCED PROFICIENCY EXAMINATION (CAPE)
PRIVATE CANDIDATES JUNE 2015 NON-NATIONALS

2. X
₌
X
₌
……………………
………..
……….
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SIGNATURE Name in BLOCK LETTERS
Ministry of Education Stamp
Receipt No
yyyy
mm
dd
Checked by
………………………………………………………………………..
Signature of Candidate
yyyy
mm
dd
Date
FOR OFFICIAL USE ONLY
First Name
Surname
(Complete in BLOCK LETTERS)
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 those subject(s) as indicated on this form. I further understand that my application wil not be considered if incorrect information is supplied. Candidates MUST check ONLINE for the accuracy of their registration during the period 19th to 23rd January, 2015 using the website “ors.cxc.org/studentportal”. You may need to enter your:- Date of Birth and Pin No., Centre No., Candidate No. and Last Name. Any inaccuracies must be reported immediately to the Supervisor of Examinations, Ministry of Education, Examinations Section, # 18 Alexandra Street, Port of Spain.
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SECTION E- DECLARATION
DECLARATION OF CANDIDATE
I,
………………………………………………………………………………………………………………………………………………………….
2011
Total
→
2012
2015
2014
2013
→
2010
Late Entry
162.00
→
YEAR
EXAMINATION
Span &/or Fren Orals
3.00
JAN
JUN
Sub-Total
If YES:
Subject
170.00
$
Candidate
118.00
→
YES
NO
Administrative
8.00
→
NB:-If any Resit box is ticked: Enter your Previous CAPE Reg. No. here:-
SECTION D - FEES
PREVIOUSLY REGISTERED PRIVATE CANDIDATES FROM JAN 2010
FEE
AMOUNT
NO. of SUBJECTS
TOTAL
5
4
3
1
2
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, Self-Tutored, Trans U1 and Trans U2 Columns, as appropriate. See Instructions, Section C
NB: If the Resit and Alternate boxes for a subject are left blank, you will be automatically registered as 'Alternate'
No.
Subjects
Repeat
Resit
Alternate
Self-tutor
Trans U1
Trans U2
SECTION B - PREFERRED CENTRE LOCATION