Government of the Republic of Trinidad and Tobago

MINISTRY OF EDUCATION
Education Towers 5 St. Vincent Street, Port of Spain, Trinidad and Tobago

Registration form
CARIBBEAN SECONDARY EDUCATION CERTIFICATE (CSEC) MAY/JUNE 2017
PRIVATE CANDIDATE NAT
Before completing this form, please read the accompanying instructions carefully. This registration form should b
completed in BLOCK LETTERS and returned to the selected registration venue (see schedule in instruction
between the period 09th November to 21st November, 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
preliminary results slip.
See Instructions,Section A

First Name
Place Photogra
Other Name

Surname Please print na

back of a r
photograph of
Sex: Male Female
and staple in t
Date of Birth(DD MM YYYY)
space prov
Birth Cert. No.
Birth Certificate pin number

Mailing Address
Street Name

Town/city

Telephone No.
Home Mobile

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.
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 ( ), u
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 be automatically registered as 'Alternate'
No. Subjects Repeat Resit Alternate
1
2
3
4
5
NB:-If any Resit box is ticked: Enter your May/June 2016 CSEC Reg. No. here:-
SECTION D - FEES
PREVIOUSLY REGISTERED AMOUNT
FEE NO. of SUBJECTS
PRIVATE CANDIDATES FROM JAN $
2010 Candidate 128.00
YES NO Administrative 8.00
If YES: Subject 130.00 X
EXAMINATION Span &/or Fren Orals 3.00 X
YEAR
JAN JUN Sub-Total
2010 Late Entry 162.00
2011
2012
2013
Total
2014
2015
2016
SECTION E- DECLARATION
DECLARATION OF CANDIDATE
I,
First Name Surname (Complete in BLOCK
declare that I make this entry in accordance with the issued instructions which I have read and understood, and that I have g
information required truthfully and accurately to the best of my knowledge. I understand that I shall be allowed to sit only th
subject(s) as indicated on this form. I further understand that my application wil not be considered if incorrect information is
Can
MUST check ONLINE for the accuracy of their registration during the period 19th to 23rd December, 2016 using the website
ors.cxc.org/studentportal. You may need to enter your:- Date of Birth and Pin No. and Last Name.
Any inaccuracies must be reported immediately to the Supervisor of Examinations, Ministry of Education, Examinations Sect
Vincent Street, Port of Spain.

. ..
Signature of Candidate yyyy
Date

FOR OFFICIAL USE ONLY

.. . .
 Receipt No yyyy mm dd
Checked
by
SIGNATURE Name in BLOCK LETTERS Ministry of Education Stamp

LIST OF TTPOST OUTLETS WHERE COURIER STICKERS CAN BE PURCHASED

DO NOT WRITE YOUR NAME NOR SIGN ON THE STICKER
DO NOT PEEL OFF ANY STICKER AND AFIX TO ENVELOPES

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

2 Port of Spain - #22 Abercombry Street, Port of Spain
3 Port of Spain - #177 tragarete Road, Port of Spain
4 St James - #61-63 Western Main Road, St James
5 St Anns - 29 St Anns Main Road, St Anns
6 Belmont- Belmont Circular Road, Belmont
7 Carenage - 546 Western Main Road, Carenage
8 Chaguanas - # 9 St Yves Street, Chaguanas
9 Couva - Cor. Bryce & La Croix Street, Couva
10 National Mail Centre - # 240-250 Golden Grove Road, Piarco
11 Tunapuna - Eastern Main Road, Tunapuna
12 TTPOST Arima- #17 Prince Street, Arima
13 San Juan - #5 Eastern Main Road, San Juan
14 Siparia - Clico Building, #1 Oropuche Road, Siparia
15 La Romain - #2 Lucky Street, La Romain
16 New Grant - 5 Seecharan Street, New Grant
17 Scarborough Post Office - Teal Building, Milford Road Scarborough, Tobago
18 Bon Accord - Milford Court, Milford Road, Bon Accord, Tobago

Envelope 1 Envelope 2

$2.00 $2.00
stamp stamp

Name Name
Address.. Address..
.. ..

Contact No. Contact No.

Envelope 3 Envelope 4 (if doing spanish)

$2.00
stamp

Name Name
Address.. Address..
.. ..

Contact No. Contact No.
NOTE: No stamp is placed on envelope 3, which is to be used for the mailing of the cer
by registered mail
At registration, the Officer will afix the appropriate sticker to both copies of ap
forms and the envelope for the certificate
 C) MAY/JUNE 2017
NATIONAL
egistration form should be
hedule in instruction sheet)
ation forms will not be

indicated on the birth

past CSEC certificates or

Place Photograph here

Please print name at the

back of a recent
photograph of yourself
and staple in the
space provided

Mobile
cate by a tick ( ), under

ed as 'Alternate'
Self-tutored

TOTAL

(Complete in BLOCK LETTERS)

nderstood, and that I have given all the
all be allowed to sit only those
d if incorrect information is supplied.
Candidates
er, 2016 using the website
e.
ucation, Examinations Section, # 5 St

. ..
mm dd
Date
E PURCHASED

ago

$2.00
stamp

$2.00
stamp
he mailing of the certifica

to both copies of applicat