2A Piccadilly Road, Kingston 5 (entrance on Manhattan Road)

Tel: 926 6573(LIME) / 618-3721(Digicel), Fax:926-8110

Email: oecexams@cwjamaica.com Website: www.overseasexams.org.jm

Caribbean Examinations Council (CXC) – CSEC Examinations – January 2014 ENTRY FORM FOR PRIVATE CANDIDATES

PLEASE WRITE IN BLOCK CAPITALS (AS WRITTEN HERE)

Candidate Details:

1. First Name: _________________________________________________________________________

Middle Name: _________________________________________________________________________ Last Name: _________________________________________________________________________

2. Date of Birth: ________ /________ /_________ 3. Gender: (Please tick √): Male ( ) Female ( ) DD / MM / YYYY

4. Mailing Address (line 1): ________________________________________________________________ (line 2): ________________________________________________________________ 5. Parish: _____________________________________ 6. Previous Registration No.: 100______________

7. E-Mail Address::________________________________________________________________________ (e.g. JOHNSMITH123@YAHOO.COM)

8. Tel. Number (Work) : ________-____________ (Cell #) ______ - _____________ (Lime)

Tel. Number (Home) : ________-____________ (Cell #) ______ - _____________ (Digicel) 9. SUBJECTS TO BE ENTERED:

Indicate by a tick (√) the subject(s) for which you wish to be entered. Please ensure that you complete each column. Do not enter any subject(s) other than those listed in the Table below.

Subjects (Choose the subject required)

Tick (√)

RESIT Carrying forward Previous SBA

Score(√)

ALT. (Paper 3/2) No SBA Score

(√)

1st

First time sitting subject

(√)

Repeat Doing over Subject

(√)

Self-Tutored

Studying on Own

(√)

School Attending School/ Private Classes

(√)

ARTS

English B (Literature) N/A N/A

BUSINESS

Office Administration

Principles of Accounts

Principles of Business

Social Studies

LANGUAGES

English A (Language) N/A N/A

Spanish* N/A N/A

SCIENCES**

Biology

Chemistry

Human & Social Biology N/A N/A

Physics

Mathematics N/A N/A

Information Technology

Total No. of Subjects Entered

(i) *Spanish: Candidates entering for CXC Spanish MUST be prepared to sit their Oral Examination as

well as Papers 1 and 2 in Kingston.

(ii) **Sciences/Information Technology: Please note Only SBA Grades for CXC May/June 2013 may be

used to Resit the Subject. P.T.O→

10. Examination Fees to be Paid:

NOTE: 1. Calculations for the number of subjects and fees have already been done to assist you in your payment. 2. Select the number of subjects for your entry and pay the applicable fee listed in the Table below.

EXAMINATION FEE STRUCTURE

NB: Candidates registering for SPANISH should ADD the Oral Fee to get the Total Amount Due

Fee Structure:

One (1) Subject

Two (2) Subjects

Three (3) Subjects

Four (4) Subjects

Five (5) Subjects

Six (6) Subjects

Entry Fee $3,585.00 $3,585.00 $3,585.00 $3,585.00 $3,585.00 $3,585.00

Subject Fee(s) $2,280.00 $4,560.00 $6,840.00 $9,120.00 $11,400.00 $13,680.00

Sub-Total $5,865.00 $8,145.00 $10,425.00 $12,705.00 $14,985.00 $17,265.00

Spanish Oral Fee ($865.00) ***If Applicable

TOTAL AMOUNT DUE

Indicate your choice with a tick (√)

NOTE: Fees are subject to review in accordance with changes in the rate of Foreign Exchange

_________________________________________________________________________________________

11. Examination Centre Preferred Location:

Select (tick √) the location most convenient for you to sit your examinations.

( ) Kingston & St. Andrew ( ) Montego Bay, St. James ( ) Portmore, St, Catherine ( ) Brown’s Town, St. Ann

( ) Spanish Town, St. Catherine ( ) Port Maria, St. Mary

( ) May Pen, Clarendon ( ) Port Antonio, Portland

( ) Mandeville, Manchester ( ) Morant Bay, St. Thomas

( ) Savanna-La-Mar, Westmoreland ( ) Santa Cruz, St., Elizabeth

NB: The availability of a Centre in the area specified is dependent upon the number of candidates requesting that Centre. Candidates will be informed of any changes using their e-mail address or telephone number provided.

Signature: _____________________________________________ Date:____________________________

Important Note:

The completed application form, and payment voucher MUST be submitted to the

Overseas Examinations Commission no later than Friday, September 27, 2013.

If the application form is not returned to this office, the candidate will not be registered

for the examination, even if payments have been made.